Urethral Stricture Disease: Evaluation of the Male Urethra

An innovative method for occluding the urethral meatus and accessing urethra strictures in retrograde urethrography in males

OBJECTIVES

To observe and evaluate the effectiveness and safety of using a sponge plug method to occlude the urethral meatus during retrograde urethrography (RUG) for accessing male urethral strictures.

METHODS

40 male patients with a mean age of 51.4 years and a history of urethral injury were primarily diagnosed with urethral stricture using a urethrocystoscope. RUG was performed using a ureteral catheter with a sponge plug inserted into the external meatus. Iodixanol, a contrast medium, was injected into the urethra or bladder for performing RUG and voiding cystourethrography (VCUG). The patients were positioned obliquely to obtain urethrograms.

RESULTS

All X-ray radiologic procedures for performing urethrography were successful without any overflow of contrast liquid observed. In all cases, the sponge plugs became visible in the resulting images. The external meatuses were directly visualized in all cases on the obtained images, allowing identification of the number, location, and length of strictures as well as coexistent pathologies such as fistulas. In one case, the plug slipped off the meatus immediately after completing the procedure. The pain Visual Analogue Scale (VAS) was 0 to 2, mean 0.35. No instances of complication or adverse reactions was observed.

CONCLUSIONS

The sponge plug effectively occludes the external urethral meatus for retrograde urethrography, enabling visualization of the actual caliber of the entire urethra, including the strictures and external meatus, by filling it with contrast liquid. This technique is safe and well-tolerated by patients.

Predictive value of systemic immune-inflammation index in recurrent urethral strictures

PURPOSE

To investigate the predictive value of systemic immune-inflammation index (SII) in recurrence of urethral stricture in patients undergoing internal urethrotomy.

METHODS

In this two-center, retrospective study, 703 patients who had internal urethrotomy for urethral stricture were included. Demographic, clinical, and laboratory characteristics and operative data were obtained. Two groups were formed from the patients as non-recurrent urethral stricture (n = 490) and recurrent urethral stricture (n = 213).

RESULTS

There was no significant difference in the mean age between the patients with and without recurrence. There was a significant difference in the mean SII values and albumin levels between the recurrence and non-recurrence groups (p = 0.001 and p = 0.006, respectively). Using a cut-off value of 252 for the SII; the sensitivity was 59.62%, the specificity was 70.41%, the positive predictive value was 46.69%, the negative predictive value was 80.05% and the accuracy was 67.14%, respectively. Statistically significant correlation was found between the presence of recurrence and the established cut-off value of the SII (p = 0.001 and p < 0.01, respectively). The risk of recurrence was stated that 3.514 times higher in patients with a SII value of ⩾252.

CONCLUSION

Using the SII the inflammatory state of the urethral tissue can be evaluated. Thus the risk of recurrence after internal urethrotomy operation can be predicted. Open urethroplasty technique instead of DVIU in patients with high SII values may increase the surgical success rates.

Exosomal MiR-381 from M2-polarized macrophages attenuates urethral fibroblasts activation through YAP/GLS1-regulated glutaminolysis

OBJECTIVE AND DESIGN

Post-traumatic urethral stricture is a clinical challenge for both patients and clinicians. Targeting glutamine metabolism to suppress excessive activation of urethral fibroblasts (UFBs) is assumed to be a potent and attractive strategy for preventing urethral scarring and stricture.

MATERIAL OR SUBJECTS

In cellular experiments, we explored whether glutaminolysis meets the bioenergetic and biosynthetic demands of quiescent UFBs converted into myofibroblasts. At the same time, we examined the specific effects of M2-polarized macrophages on glutaminolysis and activation of UFBs, as well as the mechanism of intercellular signaling. In addition, findings were further verified in vivo in New Zealand rabbits.

RESULTS

It revealed that glutamine deprivation or knockdown of glutaminase 1 (GLS1) significantly inhibited UFB activation, proliferation, biosynthesis, and energy metabolism; however, these effects were rescued by cell-permeable dimethyl α-ketoglutarate. Moreover, we found that exosomal miR-381 derived from M2-polarized macrophages could be ingested by UFBs and inhibited GLS1-dependent glutaminolysis, thereby preventing excessive activation of UFBs. Mechanistically, miR-381 directly targets the 3'UTR of Yes-associated protein (YAP) mRNA to reduce its stability at the transcriptional level, ultimately downregulating expression of YAP, and GLS1. In vivo experiments revealed that treatment with either verteporfin or exosomes derived from M2-polarized macrophages significantly reduced urethral stricture in New Zealand rabbits after urethral trauma.

CONCLUSION

Collectively, this study demonstrates that exosomal miR-381 from M2-polarized macrophages reduces myofibroblast formation of UFBs and urethral scarring and stricture by inhibiting YAP/GLS1-dependent glutaminolysis.

Which are the commonest sites and characteristics of post- transurethral prostate surgery (TPS) strictures in a high-volume reconstructive center?

BACKGROUND

Urethral stricture is a well-known complication after transurethral prostate surgery (TPS) and it is usually considered an easy-to-treat condition. We aimed to examine characteristics of post-TPS urethral stricture cases that were referred for urethroplasty at our tertiary center.

METHODS

We identified 201 patients with TPS-induced stricture treated with urethroplasty at our institution from 2017-2021. First, stricture length and location were evaluated during preoperative assessment. Second, multiple sets of multivariable logistic regression (MLR) analyses were run to assess whether clinical variables were associated with the location of the stricture.

RESULTS

Median stricture length was 5 cm (4-7). 141 (70.1%) patients received previous no-invasive treatments (dilatation and/or DVIU). Proximal bulbar urethra was the commonest site for stricture, while panurethral stricture (≥10cm) was diagnosed in 41 (20.4%) patients. Lichen sclerosus was more common in patients with penile stricture location, compared to patients with other involved segments (26% vs 19%, p=0.03), and it was the only predictor of penile and mid bulbar urethra location at MLR. Surgical approaches were augmented urethroplasty in 94% of patients, especially for patients with previous treatment including urethroplasty (95.8% vs 82.5% for naïve, p=0.004). Dorsal onlay was the preferred approach for bulbar (53.4%) and penile urethra (90.7%), while ventral onlay (38.2%) and double face augmentation (20.6%) were the preferred approach in membranous strictures.

CONCLUSIONS

The majority of patients that were referred for TPS-induced stricture attempted previous non-invasive managements. Referred TPS-induced urethral stricture were long and frequently involving multiple segments of urethra. Augmentation urethroplasty was our preferred surgical approach due to the characteristics and complexity of these strictures. The presence of lichen may increase the risk of post-TPS stricture in specific segment of urethra, namely the penile and mid-bulbar urethra.

A multimodality review of male urethral imaging: pearls and pitfalls with an update on urethral stricture treatment

Optimum radiological assessment of the male urethra requires knowledge of the normal urethral anatomy and ideal imaging techniques based on the specific clinical scenario. Retrograde urethrography is the workhorse examination for male urethral imaging, usually utilized as the initial, and often solitary, modality of choice not only in the setting of trauma, but also in the pre- and post-operative evaluation of urethral strictures. There is, however, growing interest in utilization of ultrasound and magnetic resonance for evaluation of the male urethra owing to lack of ionizing radiation and improved delineation of the adjacent tissue. We review the various modalities utilized for imaging of the male urethra for a variety of known or suspected disorders, and provide an update on current treatments of urethral strictures. Additionally, we detail the key information needed by urologists to guide management of urethral strictures. We conclude with a brief discussion of neophallus urethral diseases following female-to-male sexual confirmation surgery.