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Calenda CD, Toohey CR, Levy M, Vanmali N, Ubhi J, Ishak N, Marshall SD. Acute Kidney Injury in a Previously Healthy 56-Year-Old Male Following a Direct Visual Internal Urethrotomy of a Bulbar Stricture. Cureus 2024; 16:e59310. [PMID: 38817513 PMCID: PMC11136589 DOI: 10.7759/cureus.59310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/27/2024] [Indexed: 06/01/2024] Open
Abstract
Acute kidney injury (AKI) is a frequent finding in acutely ill and hospitalized patients arising from various etiologies. Anuric AKI, a more pronounced form of AKI in which less than 100 cc of urine is produced per day, is most frequently encountered in hospitalized, septic, and post-surgical patients, often secondary to shock or bilateral urinary tract obstruction. The development of anuric AKI in previously healthy patients after outpatient urological procedures presents a unique challenge to physicians, as many outpatient procedures require the routine perioperative administration of multiple nephrotoxic medications. Further complicating this clinical scenario, some surgical procedures that intrinsically involve iatrogenic injury to the kidney, ureter, bladder, or nearby organ can rarely lead to a phenomenon known as reflex anuria, an anuric state typically associated with AKI. Here, we report an unusual case of a previously healthy 56-year-old male who developed anuric AKI two days after direct visual internal urethrotomy (DVIU) for the treatment of a bulbar stricture. Non-contrast CT revealed no signs of an obstructive process, and laboratory findings supported an intrarenal cause of AKI. Consideration was given to non-steroidal anti-inflammatory drugs (NSAID)-induced nephrotoxicity, gentamicin-associated acute tubular necrosis, and propofol infusion syndrome, in addition to their potential synergistic effects. We also explore this as the first reported case of reflex anuria occurring at the level of the bulbar urethra, as most cases have involved direct injury to the kidney or ureter. Over the course of 10 days, our patient responded well to treatment with supportive measures and dialysis, with his vomiting, electrolyte abnormalities, renal state, and anuria eventually improving.
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Affiliation(s)
- Charles D Calenda
- College of Osteopathic Medicine, University of New England, Biddeford, USA
| | - Cameron R Toohey
- College of Osteopathic Medicine, University of New England, Biddeford, USA
| | - Madeline Levy
- College of Osteopathic Medicine, University of New England, Biddeford, USA
| | - Nisha Vanmali
- Department of Internal Medicine, Concord Hospital - Laconia, Laconia, USA
| | - Jaspreet Ubhi
- Department of Internal Medicine, Concord Hospital - Laconia, Laconia, USA
| | - Noshi Ishak
- Department of Nephrology, Concord Hospital - Laconia, Laconia, USA
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Basile G, Karakiewicz PI, Tian Z, Djinović R, Montorsi F, Barbagli G, Joshi P, Kulkarni SB, Bandini M. The impact of surgical volume on perioperative safety after urethroplasty: a population-based study. Minerva Urol Nephrol 2023; 75:381-387. [PMID: 35622351 DOI: 10.23736/s2724-6051.22.04893-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of the study was to assess whether the risk of perioperative complications after urethroplasty was affected by hospital annual surgical volume (ASV). METHODS In the Nationwide Inpatient Sample, we searched for patients who underwent urethroplasty between 2001 and 2015. Hospitals were categorized into empirically determined tertiles, according to ASV of performed urethroplasties and divided into low (<3) (LVC), intermediate (3-19) (IVC) and high (>20) volume centers (HVC). Multivariable logistic regression (MLR) analyses examined the effect of ASV on perioperative complications and on four specific sub-types of post-operative complications. RESULTS A weighted estimate of 39 912 patients underwent urethroplasty in the US. 34.9% were operated in HVC, while the rate of performed urethroplasties increased in LVC and decreased in HVC. Overall, 1.1%, 18.8% and 2.1% patients respectively experienced intraoperative, post-operative, and transfusions complications. At MLR, IVC and LVC were associated with higher risk of both intraoperative (IVC: OR 2.65, P=0.0008; LVC: OR 4.98, P<0.0001), post-operative (IVC: OR 1.14, P=0.01; LVC: OR 1.26, P=0.001) and transfusions complications (IVC: OR 1.85, P<0.001; LVC: OR 3.03, P=0.01). LVC was also associated with higher risk of hematuria (OR 3.77), urinary infections (OR 1.60) and sepsis (OR 2.83) complications. CONCLUSIONS Approximately 65% of patients were operated in IVC and LVC, and patients treated in IVC or LVC had higher risk of developing both intra and post-operative complications. These data provide important indicators for policy makers to categorize institution based on urethroplasty outcomes.
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Affiliation(s)
- Giuseppe Basile
- Unit of Urology, Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy -
| | - Pierre I Karakiewicz
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Cancer Institute of Montréal, Montréal, QC, Canada
| | - Zhe Tian
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Cancer Institute of Montréal, Montréal, QC, Canada
| | - Radoš Djinović
- Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, Belgrade, Serbia
| | - Francesco Montorsi
- Unit of Urology, Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Pankaj Joshi
- Kulkarni Reconstructive Urology Center, Pune, India
| | | | - Marco Bandini
- Unit of Urology, Division of Experimental Oncology, Department of Urology, Urological Research Institute (URI), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Cancer Institute of Montréal, Montréal, QC, Canada
- Centro Chirurgico Toscano, Arezzo, Italy
- Kulkarni Reconstructive Urology Center, Pune, India
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Bandini M, Basile G, Lazzeri M, Montorsi F, Valli B, Balò S, Barbagli G. Optimizing decision-making after ventral onlay buccal mucosa graft urethroplasty failure. BJU Int 2023; 131:339-347. [PMID: 36114780 DOI: 10.1111/bju.15895] [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: 11/30/2022]
Abstract
OBJECTIVES To evaluate factors predicting recurrence after treatment and to assess the best rescue option for patients failing buccal mucosa graft (BMG) urethroplasty. MATERIALS AND METHODS We evaluated the data from 575 patients treated with ventral onlay BMG urethroplasty. Multivariable Cox regression analysis was performed to identify predictors of BMG urethroplasty failure, and their effect on failure risk was estimated using the Kaplan-Meier method and compared using log-rank tests. Then, for those patients who underwent a rescue treatment, namely, direct visual internal urethrotomy (DVIU) vs open urethroplasty, we assessed the probability of success after retreatment using the Kaplan-Meier method and regression tree analyses. RESULTS On multivariable Cox regression analysis, only stricture length ≥5 cm (hazard ratio 3.46, 95% confidence interval 1.50-7.94; P = 0.003) was a predictor of failure. A total of 103 patients had at least one re-intervention. Notably, 12-month success rates after first rescue DVIU, second rescue DVIU, third rescue DVIU, and fourth rescue DVIU were 66.3%, 62.5%, 37.5% and 25%, respectively. Conversely, for those patients who underwent open urethroplasty retreatment, success rates at 12 months were 83.3%, 79%, 92.3% and 75% after BMG ventral onlay, first rescue DVIU, second rescue DVIU and third rescue DVIU, respectively. These data were confirmed in regression tree analyses. CONCLUSION Ventral BMG urethroplasty fails in approximately one out of five patients. Despite DVIU as a rescue treatment being a good option, its success rate becomes lower as the number of DVIU treatments performed increases. Conversely, open urethroplasty improves patient outcomes in almost three out of four patients, even in the case of previous failed DVIU treatments for stricture recurrence.
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Affiliation(s)
- Marco Bandini
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.,Centro Chirurgico Toscano, Arezzo, Italy
| | - Giuseppe Basile
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Lazzeri
- Instituto Clinico Humanitas IRCCS-Clinical and Researcher Hospital, Rozzano, Italy
| | - Francesco Montorsi
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Sofia Balò
- Centro Chirurgico Toscano, Arezzo, Italy
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Kurtzman JT, Sayegh C, Mendonca S, Chowdhury M, Kerr P, Pagan C, Zoccali MB, Brandes SB. Is colorectal mucosa a reasonable graft alternative to buccal grafts for urethroplasty?: A comparison of graft histology and stretch. Int Braz J Urol 2022; 49:41-49. [PMID: 36512454 PMCID: PMC9881816 DOI: 10.1590/s1677-5538.ibju.2022.0278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare the histological properties and stretch of colorectal mucosal grafts (CMG) and buccal mucosal grafts (BMG) and to evaluate the impact of age, medical comorbidity and tobacco use on these metrics. MATERIALS AND METHODS Samples of BMGs from patients undergoing augmentation urethroplasty were sent for pathologic review. CMGs were collected from patients undergoing elective colectomy. CMGs were harvested fresh, at full thickness from normal rectum/sigmoid. Patients with inflammatory bowel disease, prior radiation, or chemotherapy were excluded. RESULTS Seventy two BMGs and 53 CMGs were reviewed. While BMGs and CMGs were both histologically composed of mucosal (epithelium + lamina propria) and submucosal layers, the mucosal layer in CMG had crypts. The outer epithelial layers differed significantly in mean thickness (BMG 573μm vs. CMG 430μm, p=0.0001). Mean lamina propria thickness and submucosal layer thickness also differed significantly (BMG 135μm vs. CMG 400μm, p<0.0001; BMG 1090μm vs. CMG 808μm, p = 0.007, respectively). Mean delta stretch, as to length and width, was greater for CMG (118% x 72%) compared to BMGs (22% x 8%), both p<0.001. CONCLUSION CMGs and BMGs significantly differ histologically in layer composition, width and architecture, as well as graft stretch. Given its elastic properties, CMG may be useful in covering large surface areas, but its thin epithelium, thick lamina propria and additional muscularis mucosal layer could impact graft take and contracture.
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Affiliation(s)
- Jane T. Kurtzman
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Christopher Sayegh
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Shawn Mendonca
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mahveesh Chowdhury
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Preston Kerr
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Carlos Pagan
- Columbia University Irving Medical CenterDepartment of Pathology and Cell BiologyNew YorkNYUSADepartment of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Marco B. Zoccali
- Columbia University Irving Medical CenterDivision of Colorectal SurgeryDepartment of SurgeryNew YorkNYUSADivision of Colorectal Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Steven B. Brandes
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA,Correspondence address: Steven B. Brandes, MD, Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA. Fax: +1 212 305-0139 E-mail:
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Bandini M, Yepes C, Joshi PM, Basile G, Naranjo D, Bhadranavar S, Alrefaey A, Bafna S, Montorsi F, Kulkarni SB. Which are the commonest sites and characteristics of post- transurethral prostate surgery (TPS) strictures in a high-volume reconstructive center? J Endourol 2022; 36:1309-1316. [PMID: 35699078 DOI: 10.1089/end.2022.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
| | - Christian Yepes
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | - Pankaj M Joshi
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | | | - David Naranjo
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | - Shreyas Bhadranavar
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | - Ahmed Alrefaey
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | - Sandeep Bafna
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | | | - Sanjay B Kulkarni
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
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Ballesteros Ruiz C, Bandini M, Joshi PM, Bafna S, Sharma V, Yatam SL, Bhadranavar S, Patil A, Kulkarni SB. Dorsal approach for double-face bulbar urethroplasty: ventral inlay plus dorsal onlay using Kulkarni one-side dissection. Int Urol Nephrol 2022; 54:1039-1045. [DOI: 10.1007/s11255-022-03158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
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7
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Joshi PM, Bandini M, Bafna S, Sharma V, Patil A, Bhadranavar S, Yepes C, Barbagli G, Montorsi F, Kulkarni SB. Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures. EUR UROL SUPPL 2021; 35:21-28. [PMID: 34877550 PMCID: PMC8633879 DOI: 10.1016/j.euros.2021.10.009] [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] [Accepted: 10/30/2021] [Indexed: 11/08/2022] Open
Abstract
Background Graft plus flap urethroplasty is gaining momentum in patients with nearly or completely obliterated urethral strictures, in whom staged procedures or perineal urethrostomy is the only possible alternative. However, graft plus flap urethroplasty is mainly adopted for strictures involving the penile urethra. Objective To report our experience on graft plus flap urethroplasty for bulbar and penobulbar reconstruction. Design, setting, and participants Between January 2014 and June 2020, patients with nearly or completely obliterated long (>4 cm) bulbar or penobulbar strictures, who required graft plus flap urethroplasty, were considered for this study. Surgical procedure The bulbar and the penile urethra were accessed through a perineal incision and penile invagination when required. Grafts were harvested from cheek, lingual, or preputial skin and quilted over the corpora to reconstruct the dorsal plate of the neourethra. The fasciocutaneous penile flap recreated the ventral plate of the neourethra. The corpus spongiosum was flapped over the neourethra to prevent the formation of diverticula. Measurements Any need for instrumentation after surgery was defined as the primary failure. Obstructive symptoms or maximum flow rate (Qmax) below 10 ml/s, with or without a need for instrumentation, was defined as a secondary failure. Results and limitations We identified 15 patients who met the inclusion criteria. The median stricture length was 7 cm (interquartile range [IQR] 5–8 cm). The inner cheek was the preferred site for graft harvesting (53.3%). No perioperative complication of Clavien-Dindo grade ≥III were recorded in the first 30 postoperative days. The median Qmax at catheter removal was 23 ml/min (IQR 21.5–26 ml/min). The median follow-up was 25 mo (IQR 10–30 mo). The primary success rate was 86.7% (13/15) and the secondary success rate was 73.3% (11/15). Post-traumatic strictures represent a contraindication for this technique. Conclusions In referral centers, graft plus flap urethroplasty represents a feasible option for patients with nearly or completely obliterated long (>4 cm) strictures. Our study demonstrated that this option is also feasible for strictures involving mainly the bulbar urethra. Patient summary Perineal urethrostomy should be considered as the last option in patients with a nearly or completely obliterated bulbar urethral stricture. Nowadays, graft plus fasciocutaneous penile flap augmentation enriched our armamentarium of bulbar urethra reconstruction.
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Affiliation(s)
| | - Marco Bandini
- Kulkarni Reconstructive Urology Center, Pune, India.,Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.,Centro Chirurgico Toscano, Arezzo, Italy
| | | | - Vipin Sharma
- Kulkarni Reconstructive Urology Center, Pune, India
| | - Amey Patil
- Kulkarni Reconstructive Urology Center, Pune, India
| | | | | | | | - Francesco Montorsi
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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Shekar A, Gopalkrishnan G. The Story of Female Urethral Stricture - "To a man with a hammer, everything looks like a nail". Int Braz J Urol 2021; 47:1281-1283. [PMID: 34469680 PMCID: PMC8486457 DOI: 10.1590/s1677-5538.ibju.2021.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/10/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ashwin Shekar
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, India
| | - Ganesh Gopalkrishnan
- Department of Urology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, Puttaparthi, Andhra Pradesh, India
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Kalra S, Gupta P, Dorairajan LN, Ramanitharan M, Sreenivasan SK, Hota S. Does successful urethral calibration rule out significant female urethral stenosis? confronting the confounder- an outcome analysis of successfully treated female urethral strictures. Int Braz J Urol 2021; 47:829-840. [PMID: 33848077 PMCID: PMC8321492 DOI: 10.1590/s1677-5538.ibju.2020.0857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The diagnosis and treatment of female urethral stricture disease (FUSD) are practiced variably due to the scarcity of data on evaluation, variable definitions, and lack of long-term surgical outcomes. FUSD is difficult to rule out solely on the basis of a successful calibration with 14F catheter. In this study, we have tried to characterize the variable clinical presentation of FUSD, the diagnostic utility of calibration, videourodynamic study(VUDS), and urethroscopy in planning surgical management. MATERIALS AND METHODS A retrospective review of records of 16 patients who underwent surgical management of FUSD was analyzed. The clinical history, examination findings, and the results of all the investigations (including uroflowmetry, VUDS findings, urethroscopy) they underwent, the procedures they had undergone ,and the follow-up data were studied. RESULTS A total of 16 patients underwent surgical management of FUSD. 13 out of 16 patients had successful calibration with 14F catheter on the initial presentation. These 13 patients on VUDS demonstrated significant BOO and had variable stigmata of stricture on urethroscopy. The mean IPSS, flow rate, and PVR at presentation and after urethroplasty were 23.88±4.95, 7.72±4.25mL/s, 117.06±74.46mL and 3.50±3.44, 22.34±4.80mL/s, and 12.50±8.50mL, respectively. (p < 0.05). The mean flow rate after endo dilation(17F) (n=12) was 11.4±2.5mL/s while after urethroplasty improved to 20.30±4.19mL/s and was statistically significant(p < 0.05). CONCLUSIONS An adept correlation between clinical assessment, urethroscopy findings, and VUDS is key in objectively identifying FUSD and planning surgical management. A good caliber of the urethra is not sufficient enough to rule out a significant obstruction due to FUSD. Early urethroplasty provides significantly better outcomes in patients who have failed dilation as a treatment.
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Affiliation(s)
- Sidhartha Kalra
- JIPMERDepartment of Urology and Renal TransplantationPuducherryIndiaDepartment of Urology and Renal Transplantation, JIPMER, Puducherry, India
| | - Praanjal Gupta
- JIPMERDepartment of Urology and Renal TransplantationPuducherryIndiaDepartment of Urology and Renal Transplantation, JIPMER, Puducherry, India
| | - Lalgudi N. Dorairajan
- JIPMERDepartment of Urology and Renal TransplantationPuducherryIndiaDepartment of Urology and Renal Transplantation, JIPMER, Puducherry, India
| | - Manikandan Ramanitharan
- JIPMERDepartment of Urology and Renal TransplantationPuducherryIndiaDepartment of Urology and Renal Transplantation, JIPMER, Puducherry, India
| | - Sreerag Kodakkattil Sreenivasan
- JIPMERDepartment of Urology and Renal TransplantationPuducherryIndiaDepartment of Urology and Renal Transplantation, JIPMER, Puducherry, India
| | - Sovan Hota
- JIPMERDepartment of Urology and Renal TransplantationPuducherryIndiaDepartment of Urology and Renal Transplantation, JIPMER, Puducherry, India
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Barroso U, Prado F. A new double graft technique in urethroplasty for complex urethral stenosis: preliminary findings. Int Braz J Urol 2021; 47:856-860. [PMID: 33848080 PMCID: PMC8321498 DOI: 10.1590/s1677-5538.ibju.2020.1131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/29/2023] Open
Abstract
The management of complex urethral stenosis may involve different surgical techniques. As retraction of the graft may account for surgical failure, this risk increases in patients with more extensive stenosis requiring a graft of greater diameter. Although double grafts have already been used to maximize success in these cases, we propose a modified technique for urethroplasty with longitudinal urethral incision. The hypothesis was that this technique would increase the lumen by using only a urethral incision on the dorsal surface. Two patients presenting with recurrent urethral stenosis underwent urethroplasty using a double graft of oral mucosa that preserves the integrity of the spongy tissue and allows ventral inlay graft fixation using a midline relaxing incision in the portion of the urethra with stenosis. In both cases, the urethrocystoscopy and uroflowmetry performed after surgery showed a pervious and complacent urethra. After four and six months of follow-up, the postoperative outcomes were satisfactory for both patients. Further studies involving larger numbers of patients and long-term follow-up are required to evaluate the effectiveness of this method.
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Affiliation(s)
- Ubirajara Barroso
- Clínica de Distúrbios do Trato Urinário, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
| | - Filip Prado
- Clínica de Distúrbios do Trato Urinário, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brasil
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Bandini M, Barbagli G, Leni R, Cirulli GO, Basile G, Balò S, Montorsi F, Sansalone S, Salonia A, Briganti A, Butnaru D, Lazzeri M. Assessing in-hospital morbidity after urethroplasty using the European Association of Urology Quality Criteria for standardized reporting. World J Urol 2021; 39:3921-3930. [PMID: 33855598 DOI: 10.1007/s00345-021-03692-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To conduct a rigorous assessment of in-hospital morbidity after urethroplasty according with the European Association of Urology (EAU) guidelines for complication reporting. METHODS We retrospectively (2015-2019) identified 469 consecutive patients receiving urethroplasty (e.g. bulbar urethroplasty with grafts, penile urethroplasty with/without grafts/flaps, Johanson, de novo or revision perineostomy, end-to-end anastomosis, meatoplasty and/or meatotomy) at our tertiary care institution. Complications were graded with Clavien-Dindo score and Comprehensive Complication Index (CCI). Complications were classified in: bleeding no gastrointestinal, cardiac, gastrointestinal, genitourinary, infectious, neurological, oral, wound, miscellaneous, and pulmonary. Logistic regression tested for predictors of in-hospital complications and prolonged hospitalization (> 75th percentile). Kaplan-Meier and Cox regression investigated the effect of complications on failure after urethroplasty. RESULTS Overall, 161 (34.3%) patients experienced at least one complication. Of those, 47 (10%) experienced two or more complications and 59 (12.6%) experienced at least one Clavien-Dindo ≥ II complication. Only two patients had Clavien-Dindo III complications. Infectious was the most frequent complication, and de novo or revision perineostomy was associated with the highest rate of complications. The occurrence of any complications, as well as complication with Clavien-Dindo ≥ II were associated with prolonged hospitalizations, but not with higher rates of post-urethroplasty failure. CONCLUSIONS Complications after urethroplasty were common events, but rarely with severe sequelae. Infectious were the most common complications and perineostomy was the type of urethroplasty with the highest rate of complications. The application of the EAU recommendations allowed the identifications of a higher number of complications after urethroplasty if compared with previous reports based on unsupervised chart review.
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Affiliation(s)
- Marco Bandini
- Center for Reconstructive Urethra Surgery, Arezzo, Rome, Milan, Italy. .,Centro Chirurgico Toscano, Arezzo, Italy. .,Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy.
| | - Guido Barbagli
- Center for Reconstructive Urethra Surgery, Arezzo, Rome, Milan, Italy.,Centro Chirurgico Toscano, Arezzo, Italy
| | - Riccardo Leni
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe O Cirulli
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Basile
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Sofia Balò
- Centro Chirurgico Toscano, Arezzo, Italy
| | - Francesco Montorsi
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | | | - Andrea Salonia
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Urological Research Institute (URI), San Raffaele Hospital, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele Via Olgettina 60, 20132, Milan, Italy
| | - Denis Butnaru
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
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Favorito LA. In these difficult times of COVID-19, urologic research cannot stop: COVID-19 pandemic and reconstructive urology highlighted in International Brazilian Journal of Urology. Int Braz J Urol 2020; 46:496-498. [PMID: 32374121 PMCID: PMC7239294 DOI: 10.1590/s1677-5538.ibju.2020.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Luciano A Favorito
- Unidade de Pesquisa Urogenital - Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.,Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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