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Ozcan L, Polat EC, Baran C, Boylu A, Culha MG, Erkoc M, Danis E, Bozkurt M, Otunctemur A. Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy? THE FRENCH JOURNAL OF UROLOGY 2024; 34:102670. [PMID: 38909783 DOI: 10.1016/j.fjurol.2024.102670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/06/2024] [Accepted: 06/19/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Internal urethrotomy (IU) has been the most commonly used procedure for the treatment of urethral strictures (US) since it was described by Scahse in 1974. Although simple to perform and associated with a short recovery time, the main disadvantage is the high recurrence rate of stenosis. At present, there are no markers available for the prediction of recurrence after IU. The aim of this study was to evaluate the correlation between MHR and recurrence rates. METHODS The data of a total of 250 male patients who underwent IU for the first time for bulbar urethral stricture less than 2cm in our hospital between January 2011 and January 2019 were retrospectively analysed. The MHR was calculated as the ratio of monocytes to HDL-C. RESULTS In all, 78 patients experienced a recurrence while the remaining 177 did not. The stricture recurrence rate was recorded as 31.2% at the 3-year follow-up. There was a statistically significant difference in stricture length and MHR (P=0.015 and 0.001 respectively). MHR was high in the recurrent group. As a result of the Chi-square test, the positive predictive values (PPV) and negative predictive values (NPV) were 65.3% and 89.7%, respectively. ROC analysis was used to determine the optimal cut-off value. The cut-off value was found to be 1.72. CONCLUSION In our opinion, a high MHR may indicate the presence of immune inflammation and it can be used as a prognostic factor for stricture recurrence after IU. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Levent Ozcan
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey.
| | - Emre Can Polat
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Caner Baran
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Ahmet Boylu
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Mehmet Gokhan Culha
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Mustafa Erkoc
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Eyyup Danis
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Muammer Bozkurt
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
| | - Alper Otunctemur
- University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Department of Urology, Istanbul, Turkey
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Biyani CS, Kailavasan M, Sparborth T, Kozan AA, Hanchanale V, Elmamoun MH, Rajpal S, Oliveira T, Cleynenbreugel BV. Design, Development, and Validation of a First, Low-cost, Three-dimensional (3D) Printed Optical Urethrotomy Simulation Model. Urology 2024; 188:32-36. [PMID: 38508533 DOI: 10.1016/j.urology.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/22/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To develop and validate a low-cost, portable, and reusable simulation model for optical internal urethrotomy (OIU) training. METHODS A 3D-printed low-cost simulation model for OIU was designed locally and the final model was evaluated by trainees and trainers at the urology boot camps (UK, Belgium, Portugal, Poland). Participants were asked to complete a questionnaire, using a 6-item 5-point Likert Scale, to assess the model's anatomic realism. RESULTS A total of 27 trainees and 9 trainers evaluated the model. The model's anatomy and color were rated as the most realistic features, with 88.9% and 11.1% of respondents rating them as good and excellent, respectively. There were no significant differences between consultants and trainees in their assessment of any of the simulation properties of the OIU model. CONCLUSION Our study introduces an innovative, lifelike, and cost-effective simulation model for OIU training. Our model provides a realistic simulation of OIU. We feel that our low-cost and reusable model fills the gap in simulation-based training for young trainees in urology.
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Affiliation(s)
| | | | | | - Andrei A Kozan
- Department of Urology, St James's University Hospital, Leeds, West Yorkshire, UK
| | | | | | | | - Tiago Oliveira
- Hospital das Forças Arm adas - Polo Lisboa/Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Ben Van Cleynenbreugel
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Effects of hydrophilic coated catheters on urethral trauma, microtrauma and adverse events with intermittent catheterization in patients with bladder dysfunction: a systematic review and meta-analysis. Int Urol Nephrol 2022; 54:1461-1470. [PMID: 35449382 PMCID: PMC9184422 DOI: 10.1007/s11255-022-03172-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/08/2022] [Indexed: 02/08/2023]
Abstract
Background Hydrophilic coated catheters are recommended to reduce the side effects of intermittent catheterization (IC) in patients with bladder dysfunction. However, there is lack of Level one evidence to support the use of this intervention. Search methods Several electronic databases were systematically searched to evaluate complication incidences for hydrophilic coated (HC) and non-hydrophilic catheters (NHC). Results Twelve studies were eligible for inclusion in the review. The meta-analyses exploring microscopic hematuria frequencies (RR = 0.69; 95% CI 0.52–0.90) and urethral stricture frequencies (RR = 0.28; 95% CI 0.13–0.60) showed a lower risk ratio associated with HC in comparison to NHC, whereas gross hematuria was no statistically significant difference in two groups. Subgroup analyses of gross hematuria which was grouped according to "catheterization frequency", "single/multiple catheterization" and "self/other catheterization” were performed and the values of combined RR were also no statistically significant difference. Conclusions Compared with non-hydrophilic catheters, the hydrophilic coated catheters have positive significance in reducing the incidence of urethral microtrauma and the urethral stricture. However, more studies are warranted for evaluating effects of hydrophilic coated catheters on the incidence of gross hematuria. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-022-03172-x.
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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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Eredics K, Röthlin F, Wachabauer D, Sevcenco S, Marszalek M, Mock K, Madersbacher S. The long-term outcome of urethrotomy for primary urethral strictures: a population-based analysis. BJU Int 2021; 128:477-481. [PMID: 33484218 DOI: 10.1111/bju.15347] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the long-term outcome of endoscopic urethrotomy for primary urethral strictures based on a population-based approach. PATIENTS AND METHODS We analysed a nationwide database of all patients with urethral stricture disease who underwent endoscopic urethrotomy as a primary intervention between January 2006 and December 2007. All patients were followed individually for 7-9 years. Frequencies and types of surgical re-interventions were documented. Repeat surgical interventions were stratified into three treatment types: urethrotomy, urethroplasty, and end-to-end urethral anastomosis. RESULTS A total of 1203 men underwent urethrotomy during the index period. The median (SD, range) patient age was 63 (15.7, 20-85) years. A total of 136 patients (11%) died during follow-up. Within the follow-up period, 932 patients (78%) received no further surgical re-intervention for recurrent disease, and 176 patients (14.6%) required one, 53 (4.5%) two, and 41 (3.4%) three or more procedures. The mean number of re-interventions was 1.5/patient and the lowest re-intervention rate was in patients aged ≥80 years (13.9%). In 236 cases (68%) at least one repeat urethrotomy was performed. An open reconstruction was performed in 87 cases (32%), with urethroplasty in 21 patients (24%), and end-to-end anastomosis in 66 patients (76%). The mean interval until re-intervention was 29.5 months. CONCLUSIONS This long-term population-based study suggests that the invasive re-treatment rate in men following initial urethrotomy is 22% within 8 years and lowest in the advanced age cohort.
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Affiliation(s)
- Klaus Eredics
- Department of Urology, Klinik Donaustadt, Wien, Austria
| | - Florian Röthlin
- Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Wien, Austria
| | - David Wachabauer
- Austrian National Public Health Institute (Gesundheit Österreich GmbH/GÖG), Wien, Austria
| | - Sabina Sevcenco
- Department of Urology, Klinik Donaustadt, Wien, Austria.,Paracelsus Medical University, Salzburg, Austria
| | | | - Karl Mock
- Department of Urology, Klinik Donaustadt, Wien, Austria
| | - Stephan Madersbacher
- Department of Urology, Klinik Favoriten, Wien, Austria.,Sigmund Freud Private University, Wien, Austria
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Vale L, Goulao B, MacLennan G, Watkin N. Reply to Amit Bansal, Ruchir Maheshwari, and Anant Kumar's Letter to the Editor re: Beatriz Goulao, Sonya Carnell, Jing Shen, et al. Surgical Treatment for Recurrent Bulbar Urethral Stricture: A Randomised Open-label Superiority Trial of Open Urethroplasty Versus Endoscopic Urethrotomy (the OPEN Trial). Eur Urol 2020;78:572-80. Eur Urol 2020; 79:e24-e25. [PMID: 33218824 DOI: 10.1016/j.eururo.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Centre for Healthcare and Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Nick Watkin
- St George's University Hospitals NHS Foundation Trust, London, UK
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Bansal A, Maheshwari R, Kumar A. Re: Beatriz Goulao, Sonya Carnell, Jing Shen, et al. Surgical Treatment for Recurrent Bulbar Urethral Stricture: A Randomised Open-label Superiority Trial of Open Urethroplasty Versus Endoscopic Urethrotomy (the OPEN Trial). Eur Urol 2020;78:572-80. Eur Urol 2020; 79:e22-e23. [PMID: 33143950 DOI: 10.1016/j.eururo.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Amit Bansal
- Max Super Speciality Hospital Saket, Saket, New Delhi, India.
| | | | - Anant Kumar
- Max Super Speciality Hospital Saket, Saket, New Delhi, India
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Almannie R, Alturki A, AlSufyani A, Alkhamis W, Binsaleh S, Alyami F. Exposure of Urology Residents to the Management of Urethral Strictures in Saudi Arabia: Should the Program for Postgraduates Be Customized? Res Rep Urol 2020; 12:367-372. [PMID: 32984084 PMCID: PMC7490046 DOI: 10.2147/rru.s268628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to assess the exposure and knowledge of urology residents in the management of urethral stricture (US) and to determine if they would be able to perform urethroplasty after graduation and whether urethroplasty should be included as a competency in the training program. PATIENTS AND METHODS An online survey was sent to all residents enrolled in any urology training program in Saudi Arabia. Fifty-eight (approximately 50%) of the 114 residents who were sent the survey provided responses. RESULTS Most of the residents (45 residents, 77.6%) who responded were exposed to fewer than ten cases of US during their last year of training. Fifty-six residents (96.6%) attended five or fewer urethroplasty procedures in their last year of training. Twenty-three (40%) residents did not attend any urethroplasty procedure in the last year. The most common procedures attended by the residents were minimally invasive treatments (89% cystoscopy with dilatation and 79% direct visual internal urethrotomy (DVIU)). Most residents responded that they would manage newly diagnosed 1 cm US with either cystoscopy and dilatation or with DVIU 53 (91%). For the first recurrence of US, 46 (79%) residents responded that they would still prefer dilatation or DVIU. For the second, third, and chronic recurrences of US, 20 (34.5%), 6 (10.3%), and 5 (8.6%) residents, respectively, responded that they would perform dilatation or DVIU. Residents had low expectations for the success rate of urethroplasty; only 32 (55.2%) residents thought it had a high success rate. CONCLUSION Urethroplasty is a specialized urological procedure, one that residents have variable exposure to. Privilege to perform such a procedure after graduating should be modified to ensure the best outcome for patients.
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Affiliation(s)
- Raed Almannie
- Urology Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alturki
- Urology Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah AlSufyani
- Urology Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Alkhamis
- Urology Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Binsaleh
- Urology Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alyami
- Urology Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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9
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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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10
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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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Bugeja S, Payne SR, Eardley I, Mundy AR. The standard for the management of male urethral strictures in the UK: a consensus document. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820933504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The aim of this study was to establish an evidence-based best clinical practice consensus for the management of urethral stricture disease in the UK. Methods: A systematic review of optimal management of urethral stricture generated a base document which was endorsed by the British Association of Urological Surgeons (BAUS) section of Andrology and Genito-Urinary Reconstructive Surgeons (AGUS). A two-round electronic mail modified Delphi survey of 43 consultant reconstructive urologists, members of the British Association of Genito-Urinary Reconstructive Surgeons (BAGURS), was then performed. The panel’s views about the base document was sought in seven domains: definition, diagnosis, investigation, conservative, endoscopic and reconstructive treatments, and follow up. Responses were collated and used to modify the base to achieve a consensus statement. Results: In round one of the Delphi process four panel members commented on the base document and seven in round two. Consensus was thereby reached on 38 statements regarding definition (one), diagnosis (three), investigation (two), conservative/endoscopic (five) and reconstructive (24) treatments and follow up (three) for the management of urethral stricture disease. Conclusion: This consensus statement will help standardise care, provide guidance on the management of urethral stricture disease, and assist in clinical decision-making for healthcare professionals of all grades.
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Affiliation(s)
- Simon Bugeja
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Anthony R. Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
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Abstract
The diagnosis of urethral stricture disease is often made when a man with obstructive voiding symptoms undergoes flexible cystoscopy (urethroscopy). However, a more complete and definitive diagnosis is then achieved when the urethra is subsequently evaluated with a retrograde urethrogram, and in many cases, a voiding cystourethrogram (VCUG). In situations where there is stricture disease involving the meatus or fossa navicularis that prevents the passage of adult flexible cystoscope, other testing appropriate in these cases include distal urethral calibration using bougie-a-boules and possibly the advancement of a pediatric cystoscope. It is only after the exact location and length and severity of the stricture is assessed that patients can be properly advised of all options before decision-making and the implementation of a treatment plan. This section will review the evaluation of the male urethra.
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Affiliation(s)
- Joel Gelman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - James Furr
- Department of Urology, University of California, Irvine, Orange, California, USA
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Abstract
This section aims to review general principles of endoscopic management of urethral stricture disease and posterior urethral stenosis, with a special focus on the indications for treatment and technical aspects of urethral dilation and internal incision.
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Affiliation(s)
- James Furr
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, California, USA
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14
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Darlington D. A Novel Method of Local Anesthesia for Optical Internal Urethrotomy. Cureus 2019; 11:e6043. [PMID: 31824809 PMCID: PMC6886644 DOI: 10.7759/cureus.6043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Direct vision internal urethrotomy (DVIU) is the treatment of choice for short anterior urethral strictures. It is performed under spinal or general anesthesia although it can also be done under local anesthesia. We describe a novel method of local anesthesia for internal urethrotomy. The technique described is feasible in morbid patients who are deemed unfit for spinal or general anesthesia and achieves good analgesia.
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Affiliation(s)
- Danny Darlington
- Urology, Pondicherry Institute of Medical Sciences, Pondicherry, IND
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Scott KA, Li G, Manwaring J, Nikolavsky DA, Fudym Y, Caza T, Badar Z, Taylor N, Bratslavsky G, Kotula L, Nikolavsky D. Liquid buccal mucosa graft endoscopic urethroplasty: a validation animal study. World J Urol 2019; 38:2139-2145. [PMID: 31175459 DOI: 10.1007/s00345-019-02840-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/03/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To validate a novel method of urethral stricture treatment using liquid buccal mucosal grafts (LBMG) to augment direct vision internal urethrotomy (DVIU) in an animal model. MATERIALS AND METHODS A rabbit stricture model was used to test this method. Strictures were induced in 26 rabbits using electroresection of urethral epithelium. The animals were randomized into two groups: Group-1, treated with DVIU and LBMG in fibrin glue, and Group-2, DVIU with fibrin glue only. LBMG was prepared by suspension of mechanically minced buccal mucosa micrografts in fibrin glue. This LBMG-fibrin glue mixture was later injected into the urethrotomies of Group-1 animals. All animals were killed at 24 weeks after repeat retrograde urethrogram (RUG) and urethroscopy by surgeon blinded to the treatment arm. Radiographic images and histological specimens were reviewed by a radiologist and a pathologist, respectively, blinded to the treatment arm. Stricture treatment was considered a success if a diameter measured on RUG increased by ≥ 50% compared to pre-treatment RUG diameter. Histological specimens were assessed for the presence of BMG engraftment. RESULTS In Group-1, 8/12(67%) animals demonstrated engraftment of LBMG, compared to none in Group-2 (p = 0.0005). 7/12(58%) in Group-1 showed radiographic resolution/improvement of strictures compared to 5/13 Group-2 rabbits (38%, p = 0.145). The median percent change for the Group-1 was 59%, compared to 41.6% for Group-2 (p = 0.29). CONCLUSION This proof-of-concept study demonstrates feasibility of LBMG for endoscopic urethral stricture repairs. Further studies are needed to establish the role of this novel concept in treatment of urethral strictures.
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Affiliation(s)
- Kathryn A Scott
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Guanqun Li
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Jared Manwaring
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Daniela A Nikolavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yelena Fudym
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Tiffany Caza
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Zain Badar
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Nicole Taylor
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Gennady Bratslavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Leszek Kotula
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Dmitriy Nikolavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA.
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Almannie RM, Alkhamis WH, Alshabibi AI. Management of urethral strictures: A nationwide survey of urologists in the Kingdom of Saudi Arabia. Urol Ann 2018; 10:363-368. [PMID: 30386087 PMCID: PMC6194796 DOI: 10.4103/ua.ua_58_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Context: urethral strictures commonly occur and considered difficult to manage due to high recurrence rate and wide variety of management approach. Aims: This study aims to identify how urologists in Saudi Arabia manage new and recurrent urethral stricture cases and to investigate their opinions regarding urethroplasty. Settings and Design: A cross-sectional study (Online Survey) among urologists. Subjects and Methods: A nationwide survey of urologists registered with the Saudi Commission for Health Specialties was performed through a mailed questionnaire. A total of 603 urologists were selected from all five regions of Saudi Arabia, of whom 216 (35.8%) completed the questionnaire. Statistical Analysis Used: SPSS software version 23 was used for data entry and analysis. Results: Most urologists (40.3%) had treated 1–5 urethral strictures in the past year. The most common procedures used to manage urethral strictures were visual urethrotomy (82.4%), cystoscopy and dilatation (62.2%), and excision and primary anastomosis (20.8%). Minimally invasive procedures were used more frequently than any open urethroplasty techniques. Most urologists (63%) did not perform urethroplasty surgery, and 21.8% were not aware of any adult reconstructive urologists in Saudi Arabia. When used, however, the most commonly performed urethroplasty surgeries were excision and primary anastomosis, dorsal buccal graft augmented urethroplasty, and ventral buccal graft augmented urethroplasty. Conclusions: Minimally invasive methods are easy to perform and have good short-term outcomes. As such, they are more commonly used for the management of urethral strictures. On the other hand, urethroplasty surgeries are challenging procedures that require greater experience and skill.
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Affiliation(s)
- Raed M Almannie
- Department of Surgery, Urology division, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed H Alkhamis
- Department of Obstetrics and Gynecology, King Saud University Medical City, Riyadh, Saudi Arabia
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Population Analysis of Male Urethral Stricture Management and Urethroplasty Success in the United States. Urology 2018; 123:258-264. [PMID: 30170091 DOI: 10.1016/j.urology.2018.06.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/21/2018] [Accepted: 06/23/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine population-based practice patterns and outcomes related to urethroplasty for urethral stricture management. METHODS We conducted a retrospective study of adult males with urethral stricture disease treated from January 2001 to June 2015 using the Clinformatics Data Mart Database. Treatment was defined as urethral dilation, direct visualized internal urethrotomy, and urethroplasty. We then examined anterior or posterior urethroplasty outcomes defining failure as any subsequent procedure specific to urethral stricture disease occurring >30 days after urethroplasty. We used multivariable and time-to-event analysis to examine factors associated with failure. RESULTS We identified 75,666 patients treated for urethral stricture disease, with 420 and 367 undergoing anterior and posterior urethroplasty, respectively. Urethroplasty utilization doubled from 2005 to 2015. One- and 5-year failure rates for anterior and posterior urethroplasty were 25% and 18%, and 40% and 25%, respectively, with median times to failure of 5.1 and 4.1 months. Failures were salvaged primarily with direct visualized internal urethrotomy, with salvage urethroplasty in 19% and 12% of anterior and posterior repairs, respectively. CONCLUSION Despite increasing population-based urethroplasty utilization over the past decade in our insured cohort, we found higher rates of salvage treatments than reported by high-volume and expert surgeon reports. Further efforts appear warranted to balance workforce expertise and quality of urethroplasty care to meet increasing urethral stricture population needs.
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Pandey S, Aggarwal A, Goel A, Agarwal S. Scrotal oedema: a misadventure of direct vision internal urethrotomy. BMJ Case Rep 2018; 2018:bcr-2018-226829. [PMID: 30139791 DOI: 10.1136/bcr-2018-226829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, India
| | - Ajay Aggarwal
- Department of Urology, King George's Medical University, Lucknow, India
| | - Apul Goel
- Department of Urology, King George's Medical University, Lucknow, India
| | - Samarth Agarwal
- Department of Urology, King George's Medical University, Lucknow, India
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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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Simsek A, Aldamanhori R, Chapple CR, MacNeil S. Overcoming scarring in the urethra: Challenges for tissue engineering. Asian J Urol 2018; 5:69-77. [PMID: 29736368 PMCID: PMC5934514 DOI: 10.1016/j.ajur.2018.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/21/2017] [Accepted: 10/30/2017] [Indexed: 01/15/2023] Open
Abstract
Urethral stricture disease is increasingly common occurring in about 1% of males over the age of 55. The stricture tissue is rich in myofibroblasts and multi-nucleated giant cells which are thought to be related to stricture formation and collagen synthesis. An increase in collagen is associated with the loss of the normal vasculature of the normal urethra. The actual incidence differs based on worldwide populations, geography, and income. The stricture aetiology, location, length and patient's age and comorbidity are important in deciding the course of treatment. In this review we aim to summarise the existing knowledge of the aetiology of urethral strictures, review current treatment regimens, and present the challenges of using tissue-engineered buccal mucosa (TEBM) to repair scarring of the urethra. In asking this question we are also mindful that recurrent fibrosis occurs in other tissues-how can we learn from these other pathologies?
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Affiliation(s)
- Abdulmuttalip Simsek
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.,Department of Materials Science & Engineering, Kroto Research Institute, University of Sheffield, Sheffield, UK
| | - Reem Aldamanhori
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Sheila MacNeil
- Department of Materials Science & Engineering, Kroto Research Institute, University of Sheffield, Sheffield, UK
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Yenice MG, Seker KG, Sam E, Colakoglu Y, Atar FA, Sahin S, Simsek A, Tugcu V. Comparison of cold-knife optical internal urethrotomy and holmium:YAG laser internal urethrotomy in bulbar urethral strictures. Cent European J Urol 2017; 71:114-120. [PMID: 29732217 PMCID: PMC5926630 DOI: 10.5173/ceju.2017.1391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/12/2017] [Accepted: 11/13/2017] [Indexed: 01/28/2023] Open
Abstract
Introduction To compare the results of cold-knife optical internal urethrotomy (OIU) and Holmium:YAG laser internal urethrotomy (HIU) in primary bulbar urethral strictures. Material and methods A total of 63 patients diagnosed with primary bulbar urethral stricture between August 2014 and September 2015 were assigned to the OIU (n = 29) and HIU (n = 34) groups. The demographic variables, biochemistry panels, and preoperative and postoperative uroflowmetry results including the maximum flow rate (Qmax) and mean flow rate (Qmean) values, retrograde urethrography, and diagnostic flexible urethroscopy findings were recorded prospectively. Demographic features and preoperative values were not statistically different between groups (p >0.05). Mean surgical times were 18.4 ±2.3 min for OIU and 21.9 ±3.8 min for HIU groups, which was statistically significant (p <0.05). There was no significant difference in complication rates in both groups (p = 0.618). Results Postoperative Qmax values were increased in both groups even though postoperative Qmax values were not significantly different between the two groups in the short- and long-term results at 3, 6, and 12 months (p >0.05). There was no recurrence in the first 3 months in either group. The urethral stricture recurrence rate up to month 12 was not statistically significant for the OIU group (n = 6, 20.7%) as compared to the HIU group (n = 11, 32.4%; p = 0.299). At follow-up, the SFR and IFR was 96% and 88% at 3-months, and 82% and 71% at 12-months, respectively (p <0.001). While almost three-quarters of patients were stone and infection free at 12-months, the majority of those with stones recurrence also had recurrence of their UTI. Conclusions HIU is an alternative method to OIU, and it has similar success rates in the treatment of short segment bulbar urethral strictures.
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Affiliation(s)
- Mustafa Gurkan Yenice
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Kamil Gokhan Seker
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Emre Sam
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Yunus Colakoglu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Feyzi Arda Atar
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Selcuk Sahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Abdulmuttalip Simsek
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
| | - Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey, Istanbul
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Pathak HR, Jain TP, Bhujbal SA, Meshram KR, Gadekar C, Parab S. Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty. Turk J Urol 2017; 43:350-354. [PMID: 28861310 DOI: 10.5152/tud.2017.30771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/06/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare long- term outcomes of buccal mucosa graft (BMG) augmentation urethroplasty for long segment bulbar urethral strictures done by placing the graft ventrally, dorso-laterally and dorsally. MATERIAL AND METHODS We conducted a single institution retrospective study on 112 who underwent BMG augmentation urethroplasty for non-traumatic bulbar urethral strictures between January 2005 to December 2014. The cases were divided into three groups based on the site of placement of BMG graft i.e. (a) Ventral (n=44), (b) Dorso-lateral (n=48) and (c) Dorsal (n=20). Follow-up period was from one year to five years. Patients with failed outcomes underwent urethroscopy or retrograde urethrogram to note the site of recurrence of stricture. RESULTS Out of 112 cases 91 (81%) were successful and 21 (19%) failed. The success rates for ventral, dorso-lateral and dorsal BMG augmentation procedures were 89%, 79% and 70%, respectively (p=0.18). Among 21 failed cases, 12 cases (57%) had stricture at proximal anastomotic site, 4 cases (19%) at graft and 5 cases (24%) at distal anastomotic site (p=0.01). CONCLUSION The overall success rate for BMG augmentation urethroplasty is equal for all techniques. Ventral onlay urethroplasty provides better exposure of proximal anastomotic site thus it is associated with minimum proximal anastomotic site recurrence rates. Patients with extensive spongiofibrosis and long segment strictures had higher rates of failure.
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Kluth LA, Ernst L, Vetterlein MW, Meyer CP, Reiss CP, Fisch M, Rosenbaum CM. Direct Vision Internal Urethrotomy for Short Anterior Urethral Strictures and Beyond: Success Rates, Predictors of Treatment Failure, and Recurrence Management. Urology 2017; 106:210-215. [PMID: 28479479 DOI: 10.1016/j.urology.2017.04.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/23/2017] [Accepted: 04/25/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine success rates, predictors of recurrence, and recurrence management of patients treated for short anterior urethral strictures by direct vision internal urethrotomy (DVIU). MATERIALS AND METHODS We identified 128 patients who underwent DVIU of the anterior urethra between December 2009 and March 2016. Follow-up was conducted by telephone interviews. Success rates were assessed by Kaplan-Meier estimators. Predictors of stricture recurrence and different further therapy strategies were identified by uni- and multivariable Cox regression analyses. RESULTS The mean age was 63.8 years (standard deviation: 16.3) and the overall success rate was 51.6% (N = 66) at a median follow-up of 16 months (interquartile range: 6-43). Median time to stricture recurrence was six months (interquartile range: 2-12). In uni- and multivariable analyses, only repeat DVIU (hazard ratio [HR] = 1.87, 95% confidence interval (CI) = 1.13-3.11, P= .015; and HR=1.78, 95% CI = 1.05-3.03, P = .032, respectively) was a risk factor for recurrence. Of 62 patients with recurrence, 35.5% underwent urethroplasty, 29% underwent further endoscopic treatment, and 33.9% did not undergo further interventional therapy. Age (HR = 1.05, 95% CI = 1.01-1.09, P = .019) and diabetes (HR = 2.90, 95% CI = 1.02-8.26, P = .047) were predictors of no further interventional therapy. CONCLUSION DVIU seems justifiable in short urethral strictures as a primary treatment. Prior DVIU was a risk factor for recurrence. In case of recurrence, about one-third of the patients did not undergo any further therapy. Higher age and diabetes predicted the denial of any further treatment.
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Affiliation(s)
- Luis A Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Ernst
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Philip Reiss
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clemens M Rosenbaum
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Akkoc A, Aydin C, Kartalmıs M, Topaktas R, Altin S, Yilmaz Y. Use and outcomes of amplatz renal dilator for treatment of urethral strictures. Int Braz J Urol 2017; 42:356-64. [PMID: 27256192 PMCID: PMC4871399 DOI: 10.1590/s1677-5538.ibju.2014.0578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 09/09/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Urethral stricture disease is still a major problem in men. Many procedures are available for the treatment of urethral strictures; urethral dilatation is one of the oldest. The blind dilatation of urethral strictures may be a difficult and potentially dangerous procedure. The purpose of this study was to describe safe urethral dilatation using amplatz renal dilator and to report outcomes. Materials and Methods From 2010 to 2014, a total of 26 men with primary urethral strictures were managed by urethral dilatation using amplatz renal dilators. The parameters analyzed included presentation of patients, retrograde urethrography (RGU) findings, pre-and postoperative maximum flow rate (Qmax) on uroflowmetry (UF) and post-void residual urine (PVR). Patients were followed-up at 1.6 and 12 months. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guidewire and stylet over which amplatz renal dilators are introduced. Results The mean age of the patients was 57.6 (35–72) years. The median stricture length was 0.82 (0.6–1.5)cm. Pre-operative uroflowmetry showed Qmax of 7.00 (4–12) mL/sec and ultrasonography showed PVR of 75.00 (45–195)mL. Postoperatively, Qmax improved to 18.00 (15–22)mL/sec (p<0.001) at 1 month, 17.00 (13–21)mL/sec (p<0.001) at 6 months and 15.00 (12–17)mL/sec (p<0.001) at 12 months. The post-operative PVR values were 22.50 (10–60)mL (p<0.001), 30.00 (10–70)mL (p<0.001) and 30.00 (10–70) mL (p<0.001) at 1.6 12 months, respectively. The median procedure time was 15.00 (12–22) minutes. None of the patients had a recurrence during a 12-month period of follow-up. Conclusion Urethral dilatation with amplatz renal dilators avoids the risks associated with blind dilatation techniques. This tecnique is a safe, easy, well-tolerated and cost-effective alternative for treatment of urethral strictures.
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Affiliation(s)
- Ali Akkoc
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Cemil Aydin
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Mahir Kartalmıs
- Department of Urology, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey
| | - Ramazan Topaktas
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Selcuk Altin
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Yakup Yilmaz
- Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Ekeke O, Amusan O. Clinical presentation and treatment of urethral stricture: Experience from a tertiary hospital in Port Harcourt, Nigeria. AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Antegrade cystoscopic light source guided laser urethrotomy for the treatment of completely obliterated urethra. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
OBJECTIVE To evaluate the long-term success rate of direct vision internal urethrotomy as a treatment for anterior urethral strictures. MATERIALS AND METHODS We retrospectively analyzed the results for patients who underwent internal urethrotomy from January 2009 to January 2014 for anterior urethral strictures. Patients were followed till January 2016. Patients with complicated urethral strictures with a history of previous urethroplasty, hypospadias repair, or previous radiation were excluded from the study, as anticipated low success rate of direct visual internal urethrotomy (DVIU) in these patients. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, and third urethrotomy. RESULTS A total of 186 patients were included in this study. Stricture-free rates after first, second, and third urethrotomy were 29.66%, 22.64%, and 13.33%, respectively. CONCLUSIONS Although DVIU may be a management option for anterior urethral stricture disease, it seems that long-term results are disappointing.
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Affiliation(s)
- Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Sanjay Kumar
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Bastab Ghosh
- Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
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Abstract
Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0–9%). Urethroplasty has a much higher chance of success (85–90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether.
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Novel Concept and Method of Endoscopic Urethral Stricture Treatment Using Liquid Buccal Mucosal Graft. J Urol 2016; 196:1788-1795. [DOI: 10.1016/j.juro.2016.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/18/2022]
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Modified platelet-rich plasma with transforming growth factor β1 neutralization antibody injection may reduce recurrence rate of urethral stricture. Med Hypotheses 2016; 97:1-3. [PMID: 27876114 DOI: 10.1016/j.mehy.2016.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/18/2016] [Indexed: 01/15/2023]
Abstract
Urethral stricture is one of the most bothersome urologic disease among urologists and has a substantial impact on quality of life and healthcare costs. Although it can be cured with internal urethrotomy easily, post-surgery stricture recurrence is challenging. Several adjuvant therapies have been used in conjunction with internal urethrotomy but none of them are used routinely because the pathophysiology of the disease is still obscure. Fibrosis is the most accused hypothesis for the action. Platelet-rich plasma (PRP) is an autologous blood product containing a high concentration of platelets that is being used for a very wide range of clinical healing applications. It comprises a concentration of fundamental protein growth factors shown to be actively excreted by platelets to initiate accurate wound healing. Although PRP can play a critical role in wound healing and has been used in fibrotic diseases successfully, it has some deleterious cytokines such as transforming growth factor β1 (TGF β1) which can also cause fibrosis. The new hypothesis is that the subcutaneous injection of neutralized platelet-rich plasma with TGFβ1 antibody at the planned urethrotomy site may prevent recurrence and provide superior healing and long-term results.
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Siegel JA, Morey AF. Editorial - The case for excision and primary anastomotic urethroplasty for bulbar urethral stricture. Int Braz J Urol 2016; 42:868-871. [PMID: 27716454 PMCID: PMC5066880 DOI: 10.1590/s1677-5538.ibju.2016.05.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jordan A Siegel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Tolkach Y, Herrmann T, Merseburger A, Burchardt M, Wolters M, Huusmann S, Kramer M, Kuczyk M, Imkamp F. Development of a clinical algorithm for treating urethral strictures based on a large retrospective single-center cohort. F1000Res 2016; 5:2378. [PMID: 28529689 PMCID: PMC5414819 DOI: 10.12688/f1000research.9427.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 11/20/2022] Open
Abstract
Aim: To analyze clinical data from male patients treated with urethrotomy and to develop a clinical decision algorithm. Materials and methods: Two large cohorts of male patients with urethral strictures were included in this retrospective study, historical (1985-1995, n=491) and modern cohorts (1996-2006, n=470). All patients were treated with repeated internal urethrotomies (up to 9 sessions). Clinical outcomes were analyzed and systemized as a clinical decision algorithm. Results: The overall recurrence rates after the first urethrotomy were 32.4% and 23% in the historical and modern cohorts, respectively. In many patients, the second procedure was also effective with the third procedure also feasible in selected patients. The strictures with a length ≤ 2 cm should be treated according to the initial length. In patients with strictures ≤ 1 cm, the second session could be recommended in all patients, but not with penile strictures, strictures related to transurethral operations or for patients who were 31-50 years of age. The third session could be effective in selected cases of idiopathic bulbar strictures. For strictures with a length of 1-2 cm, a second operation is possible for the solitary low-grade bulbar strictures, given that the age is > 50 years and the etiology is not post-transurethral resection of the prostate. For penile strictures that are 1-2 cm, urethrotomy could be attempted in solitary but not in high-grade strictures. Conclusions: We present data on the treatment of urethral strictures with urethrotomy from a single center. Based on the analysis, a clinical decision algorithm was suggested, which could be a reliable basis for everyday clinical practice.
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Affiliation(s)
- Yuri Tolkach
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany.,Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - Thomas Herrmann
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | - Axel Merseburger
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | | | - Mathias Wolters
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | - Stefan Huusmann
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | - Mario Kramer
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | - Markus Kuczyk
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
| | - Florian Imkamp
- Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany
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Yürük E, Yentur S, Çakır ÖO, Ertaş K, Şerefoğlu EC, Semerciöz A. Catheter dwell time and diameter affect the recurrence rates after internal urethrotomy. Turk J Urol 2016; 42:184-9. [PMID: 27635294 DOI: 10.5152/tud.2016.90490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cold-knife direct vision internal urethrotomy (DVIU) is frequently used as the first-line treatment for urethral stricture disease. Although the steps of the procedure are defined in detail, the duration of catheterization and the diameter of the catheter to be used after the operation are not clearly defined. The aim of this study is to evaluate the effects of catheter dwell time and diameter on recurrence rates of urethral stricture disease after DVIU. MATERIAL AND METHODS Data of 193 consecutive treatment naïve bulbar urethral stricture patients who underwent DVIU between January 2009 and June 2013 were retrospectively analyzed. Patient demographics and stricture characteristics were noted. Catheter dwell times were grouped as <5 and ≥5 days. The diameters of catheters used were 16, 18 and 22 Fr. The association between recurrence rates, catheter dwell times, and diameter were evaluated with Tukey's test and Pearson's correlation test, respectively. RESULTS Overall 193 patients with a mean age of 64.51±12.99 (range: 17 to 85) years were enrolled in the study. Urethral stricture disease recurred in 45 (23.31%) patients within the first year after DVIU. Mean duration of catheterization was 7.47±4.03 and 4.79±1.94 days in patients with and without recurrences, respectively (p=0.0001). Catheter dwell times for ≥5 days were also associated with increased recurrence (p=0.0001). Of the patients with recurrent strictures, 16, 18 and 22Fr catheters were placed in 22.22%, 20% and 57.78% of the patients, respectively. Increased catheter diameter was also associated with higher recurrence rates (p=0.004). CONCLUSION Shortening the postoperative duration of catheterization and decreasing the catheter size may result in improved recurrence rates after DVIU. Further prospective randomized trials are necessary to confirm these findings.
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Affiliation(s)
- Emrah Yürük
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Serhat Yentur
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Ömer Onur Çakır
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Kasım Ertaş
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Ege Can Şerefoğlu
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - Atilla Semerciöz
- Clinic of Urology, Bağcılar Training and Research Hospital, İstanbul, Turkey
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Nikolavsky D, Abouelleil M, Daneshvar M. Transurethral ventral buccal mucosa graft inlay urethroplasty for reconstruction of fossa navicularis and distal urethral strictures: surgical technique and preliminary results. Int Urol Nephrol 2016; 48:1823-1829. [PMID: 27470030 DOI: 10.1007/s11255-016-1381-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 07/19/2016] [Indexed: 01/28/2023]
Abstract
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.
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Affiliation(s)
- Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
| | - Mourad Abouelleil
- Department of Urology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Michael Daneshvar
- Department of Urology, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
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Zhou SK, Zhang J, Sa YL, Jin SB, Xu YM, Fu Q, Lazzeri M. Etiology and Management of Male Iatrogenic Urethral Stricture: Retrospective Analysis of 172 Cases in a Single Medical Center. Urol Int 2016; 97:386-391. [PMID: 27296973 DOI: 10.1159/000444592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/08/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the etiology and management of male iatrogenic urethral stricture in China. METHODS The data of 172 patients with iatrogenic urethral stricture who underwent treatment at a high volume reference center in China from January 2008 to February 2014 were analyzed retrospectively. Databases were analyzed to understand the impact of different types of iatrogenic injury on stricture location, length and treatment of urethral strictures, as well as success rates. RESULTS The most common type of iatrogenic stricture was urethral instrumentations in 80 patients (46.51%). Mean stricture length was 3.3 ± 2.54 cm and the longest strictures were those caused by intravesical instillation. Substitution urethroplasty was the most common intervention and was performed in 60.47% (104/172) of patients. The overall success rate was 85.00% (136/160). Univariable analyses revealed that the type of iatrogenic injury was significantly related to restenosis (p = 0.036), and it is more apt to postoperative restenosis in the type of intravesical instillation than others. CONCLUSION Our results showed that urethral instrumentation is the most common etiology of iatrogenic urethral stricture, and most iatrogenic urethral strictures involve the anterior urethra. The different etiologies are closely associated with stricture location, length and the overall prognosis of urethral strictures.
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Affiliation(s)
- Shu-Kui Zhou
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts.
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Affiliation(s)
- Thomas G Smith
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Abstract
Excision and end-to-end anastomosis (EPA) has been the preferred urethroplasty technique for short bulbar strictures and is associated with an excellent functional outcome. Driven by concerns over the potential morbidity associated with dividing the urethra, therefore compromising spongiosal blood flow, as well as spongiofibrosis being superficial in the majority of non-traumatic bulbar strictures, the non-transecting technique for bulbar urethroplasty has been developed with the aim of achieving the same success as EPA without the morbidity associated with transection. This manuscript highlights the fundamental principles underlying the ongoing debate-transection or non-transection of the strictured bulbar urethra? The potential advantages of avoiding dividing the corpus spongiosum of the urethra are discussed. The non-transecting anastomotic procedure together with its various modifications are decribed in detail. Our experience with this technique is presented. Non-transecting excision of spongiofibrosis with preservation of well vascularised underlying spongiosum provides an excellent alternative to dividing the urethra during urethroplasty for short non-traumatic proximal bulbar strictures.
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Affiliation(s)
- Simon Bugeja
- Reconstructive Urology Unit, University College London Hospital, London NW1 2BU, UK
| | - Daniela E Andrich
- Reconstructive Urology Unit, University College London Hospital, London NW1 2BU, UK
| | - Anthony R Mundy
- Reconstructive Urology Unit, University College London Hospital, London NW1 2BU, UK
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Djordjevic ML. Treatment of Urethral Stricture Disease by Internal Urethrotomy, Dilation, or Stenting. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.eursup.2015.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Siegel JA, Panda A, Tausch TJ, Meissner M, Klein A, Morey AF. Repeat Excision and Primary Anastomotic Urethroplasty for Salvage of Recurrent Bulbar Urethral Stricture. J Urol 2015; 194:1316-22. [DOI: 10.1016/j.juro.2015.05.079] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Jordan A. Siegel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arabind Panda
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Timothy J. Tausch
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew Meissner
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexandra Klein
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Allen F. Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Siegel JA, Morey AF. Substitution urethroplasty or anastomotic urethroplasty for bulbar urethra strictures? Or endoscopic urethrotomy? Opinion: Anastomotic Urethroplasty. Int Braz J Urol 2015; 41:615-8. [PMID: 26401851 PMCID: PMC4756987 DOI: 10.1590/s1677-5538.ibju.2015.0266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jordan A Siegel
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Ishii G, Naruoka T, Kasai K, Hata K, Omono H, Suzuki M, Kimura T, Egawa S. High pressure balloon dilation for vesicourethral anastomotic strictures after radical prostatectomy. BMC Urol 2015; 15:62. [PMID: 26134267 PMCID: PMC4487584 DOI: 10.1186/s12894-015-0059-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 06/16/2015] [Indexed: 11/26/2022] Open
Abstract
Background Vesicourethral anastomotic stricture (VAS) is a rare but serious complication following radical prostatectomy (RP), and various types of managements for VAS have been proposed. We investigated the efficacy of transurethral balloon dilation in the management of VAS after RP. Methods A total of 128 consecutive patients underwent open RP at our hospital between 2008 and 2013; of these, 10 patients (7.8 %) developed VAS. Transurethral balloon dilation was performed in all 10 patients, using a high pressure balloon catheter under fluoroscopic and endoscopic guidance. Follow-up endoscopy was performed, and patients in whom the stricture had recurred underwent repeat dilation. We retrospectively evaluated the management of VAS and short-term efficacy of high pressure balloon dilation. Results The mean time from RP to diagnosis of VAS was 9 months (2–40 months); eight patients (80 %) were diagnosed within 6 months of RP. Balloon dilation of VAS was technically successful in all patients, and no perioperative complications were recorded. The median follow-up after balloon dilation was 24 months (7–67 months). There was no recurrence of VAS in eight patients (80 %) after the first balloon dilation, and all patients were controlled within the twice. Conclusion High pressure balloon dilation is a highly effective and minimally invasive procedure for treating VAS.
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Affiliation(s)
- Gen Ishii
- Atsugi City Hospital, 1-16-36 Mizuhiki, zip 243-8588, Atsugi City, Kanagawa, Japan.
| | - Takehito Naruoka
- Jikei University School of Medicine, 3-25-8 Nishishinbashi minato-ku, zip 105-8461, Tokyo, Japan.
| | - Kanako Kasai
- Atsugi City Hospital, 1-16-36 Mizuhiki, zip 243-8588, Atsugi City, Kanagawa, Japan.
| | - Kenichi Hata
- Atsugi City Hospital, 1-16-36 Mizuhiki, zip 243-8588, Atsugi City, Kanagawa, Japan.
| | - Hiroshi Omono
- Atsugi City Hospital, 1-16-36 Mizuhiki, zip 243-8588, Atsugi City, Kanagawa, Japan.
| | - Masayasu Suzuki
- Atsugi City Hospital, 1-16-36 Mizuhiki, zip 243-8588, Atsugi City, Kanagawa, Japan.
| | - Takahiro Kimura
- Jikei University School of Medicine, 3-25-8 Nishishinbashi minato-ku, zip 105-8461, Tokyo, Japan.
| | - Shin Egawa
- Jikei University School of Medicine, 3-25-8 Nishishinbashi minato-ku, zip 105-8461, Tokyo, Japan.
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A prospective, randomized trial to evaluate the efficacy of clean intermittent catheterization versus triamcinolone ointment and contractubex ointment of catheter following internal urethrotomy: long-term results. Int Urol Nephrol 2015; 47:909-13. [DOI: 10.1007/s11255-015-0990-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
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Current trends in urethral stricture management. Asian J Urol 2015; 1:46-54. [PMID: 29511637 PMCID: PMC5832879 DOI: 10.1016/j.ajur.2015.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/19/2014] [Accepted: 08/26/2014] [Indexed: 01/16/2023] Open
Abstract
The recent International Consultation on Urological Disease (ICUD) panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis, as distinct from sphincter stenoses and a urethral disruption injury. Whenever possible, an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty. There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used, but clearly the extent of the spongiofibrosis and individual anatomical factors (the length of the penis and urethra) are important, the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee. More recently, there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique. Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps, as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results. It is important that the reconstructive surgeon is well versed in the full range of available repair techniques, as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.
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Urethral strictures in men with neurogenic lower urinary tract dysfunction using intermittent catheterization for bladder evacuation. Spinal Cord 2015; 53:310-3. [PMID: 25644391 DOI: 10.1038/sc.2015.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/06/2015] [Accepted: 01/08/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective investigation. OBJECTIVES To investigate the occurrence, characteristics and clinical consequences of urethral strictures in men with neurogenic lower urinary tract dysfunction (NLUTD) using intermittent catheterization (IC) for bladder evacuation. SETTING Spinal cord injury rehabilitation center. METHODS The patient database was screened for men with NLUTD who had presented for a routine video-urodynamic investigation between 2008 and 2012. Patient characteristics, bladder diary details, the occurrence of urethral strictures and performed urethrotomy procedures were collected from patient charts. Urethral strictures were classified using the Wiegand scoring system modified for men with NLUTD. RESULTS The occurrence rate of urethral strictures (that is, 25% confidence interval (CI) 21-30%) was significantly (P=0.0001) higher in men using IC (n=415) than in men using other bladder evacuation methods (that is, 14% CI 11-17%) (n=629). Urethral strictures had occurred after a median 5.9 years (range 0.5-48.9 years) of IC. There was no significant (P>0.08) effect of tetraplegia or catheter type on the stricture occurrence rate. Approximately one-third of the men suffering from urethral strictures underwent internal urethrotomies. The radiographic stricture severity score was not associated with the need for surgical correction of the stricture. The radiographic recurrence rate of urethral strictures in operated men was 100%, a median 14 years after the first urethrotomy. CONCLUSIONS The occurrence rate of urethral strictures is significantly higher in men using IC than in men using other bladder evacuation methods. Every fourth men using IC may be affected by urethral strictures. However, only every third stricture may require a surgical intervention.
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Hillary CJ, Osman NI, Chapple CR. WITHDRAWN: Current trends in urethral stricture management. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Granieri MA, Peterson AC. The management of bulbar urethral stricture disease before referral for definitive repair: have practice patterns changed? Urology 2014; 84:946-9. [PMID: 25109557 DOI: 10.1016/j.urology.2014.06.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/06/2014] [Accepted: 06/09/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the management of patients with bulbar urethral stricture disease before referral for definitive urethroplasty and determine if practice patterns have changed with respect to endoscopic interventions. MATERIALS AND METHODS We performed an institutional review board-approved retrospective review and recorded patient demographics, stricture-related information, and all procedures performed for bulbar urethral stricture disease before initial presentation at our institution. Included procedures were: UroLume stent (AMS, Minnetonka, MN), laser urethrotomy, direct visual urethrotomy (DVIU), and dilation of urethral stricture. Patients with prior urethroplasty were excluded. We compared the differences between procedures when stratified by stricture length. RESULTS We identified 363 men who underwent urethroplasty for bulbar urethral stricture disease from January 1996 to September 2011. Of the total, 235 men (65%) had a prior DVIU, whereas 65 of these men (28%) had multiple DVIUs. One hundred ninety-nine men (55%) had a prior dilation and 155 of these men (78%) had multiple dilations. The remaining procedures consisted of laser urethrotomy (6; 2%), and UroLume stent (4; 1%). Twenty-four patients (6%) had no procedures before referral. There was no statistically significant difference between numbers of prior procedures when stratified by stricture length. From 1996 to 2010, there was no appreciable change in number of procedures before referral, with ∼ 70% of patients with ≥ 2 prior procedures. CONCLUSION Our institution has not seen a measurable change in practice patterns before referral from 1996 to 2010. Future studies are needed to determine if the change in referral patterns in 2011 represents a future trend.
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Affiliation(s)
- Michael A Granieri
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC.
| | - Andrew C Peterson
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC
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Zhang K, Qi E, Zhang Y, Sa Y, Fu Q. Efficacy and Safety of Local Steroids for Urethra Strictures: A Systematic Review and Meta-Analysis. J Endourol 2014; 28:962-8. [PMID: 24745607 DOI: 10.1089/end.2014.0090] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kaile Zhang
- Department of Urology, Sixth People's Hospital , affiliated to Shanghai Jiaotong University, Shanghai, China
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Tian Y, Wazir R, Yue X, Wang KJ, Li H. Prevention of stricture recurrence following urethral endoscopic management: what do we have? J Endourol 2014; 28:502-8. [PMID: 24341856 DOI: 10.1089/end.2013.0538] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. This review was performed to determine the best strategy for stricture recurrence prevention following urethral endoscopic management. METHODS We reviewed the published literature in PubMed, the Cochrane Library, and Google Scholar focusing on this intractable problem regardless of language restrictions. Outcomes of interest included the study methods and the applied strategy's efficacy. The level of evidence and grade of recommendations of included studies were appraised with an Oxford Centre for Evidence-Based Medicine Scale. RESULTS Currently, numerous techniques, including catheterization, repeated dilation, brachytherapy, and intraurethral use of various antifibrosis agents, have been employed to oppose the process of wound contraction or regulate the extracellular matrix. But unfortunately, none of these techniques or agents have demonstrated efficacy with enough evidence. CONCLUSIONS Although lots of strategies are available, still, we do not have a suitable, single optimum solution for all the conditions. The clinical decision of stricture-recurrence-prevention techniques should be carefully tailored to every individual patient. As the studies are not sufficient, more efforts are warranted to address this interesting but challenging issue.
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Affiliation(s)
- Ye Tian
- Department of Urology, West China Hospital, Sichuan University , Chengdu, P.R. China
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Abstract
Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8-80%, with long-term success rates of 20-30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85-90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.
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Affiliation(s)
- Lindsay A Hampson
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Jack W McAninch
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
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Buckley JC, Heyns C, Gilling P, Carney J. SIU/ICUD Consultation on Urethral Strictures: Dilation, internal urethrotomy, and stenting of male anterior urethral strictures. Urology 2013; 83:S18-22. [PMID: 24286602 DOI: 10.1016/j.urology.2013.08.075] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/23/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
Male urethral stricture is one of the oldest known urologic diseases, and continues to be a common and challenging urologic condition. Our objective was to review all contemporary and historial articles on the topic of dilation, internal urethrotomy, and stenting of male anterior urethral strictures. An extensive review of the scientific literature concerning anterior urethral urethrotomy/dilation/stenting was performed. Articles were included that met the criteria set by the International Consultation on Urological Diseases (ICUD) urethral strictures committee and were classified by level of evidence using the Oxford Centre for Evidence-Based Medicine criteria adapted from the work of the Agency for Health Care Policy and Research as modified for use in previous ICUD projects. Using criteria set forth by the ICUD, a committee of international experts in urethral stricture disease reviewed the literature and created a consensus statement incorporating levels of evidence and expert opinion in regard to dilation, internal urethrotomy, and stenting of male anterior urethral strictures.
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Affiliation(s)
| | - Chris Heyns
- Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa
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