Anterior Urethra Research Articles

Advanced Malignant Melanoma of the Vulva in a 70 years old woman

Vulvar melanoma is a rare malignant tumor of the female genital tract tend to occur in older age women and a high tendency to metastasize because the diagnosis is usually delayed (1). In this case report, we present a 70-year-old para 8 woman who presented with progressively increasing vulvar swelling of 2 years and multiple visit to health institution. Examination revealed 7cm diameter multi-nodular mass with areas of dark and dark blue-violet color filling the introitus that involves the clitoris, labia minora, lower third of the anterior vagina and urethra. Incisional biopsy from the mass showed malignant melanoma. Imaging with CT scan revealed bilateral lung metastasis. Palliative chemotherapy was planned but the patient lost to follow up.

Changes in practices concerning urethral stricture surgery: Analysis of French data for the period 2013–2022

IntroductionThe prevalence of urethral stricture is estimated at 0.9%. American, European and French recommendations have reduced the place of endoscopic treatments due to their poor outcomes, especially in the case of repeated procedures. Urethroplasty is the new reference treatment for urethral stricture. Our aim was to assess the evolution of national practices from 2013 to 2022. Material and methodsWe collected national CCAM coding data for all procedures involving urethral stricture surgery using the Scansanté internet platform produced by the Technical Agency for Information on Hospitalization, which prospectively collects all procedures coded according to CCAM coding from public, liberal and ESPIC healthcare structures. ResultsThe overall number of urethral surgical procedures has been steadily increasing over the past 10 years. Endoscopic procedures remain largely predominant in 2022, totaling 23,982, but have remained stable over the decade. Urethroplasties have been on the rise since 2019, reaching 1600 cases in 2022 compared with 1100 cases in 2020. Although urethrotomies currently outnumber urethroplasties by a factor of 10, this ratio has been consistently decreasing since 2016. The most significant contributor to the 10-year increase is urethroplasty by augmentation, particularly free flap techniques on the anterior urethra. Resection-anastomosis and urethrostomy techniques have remained stable. DiscussionIn 2022, endoscopic treatments remain by far the majority, but urethroplasties are on the increase. A significant number of patients can benefit from initial endoscopic treatment because short bulbar localization is the most common presentation, but long-term success rates are poor compared to urethroplasty, which boasts approximately 80% success rates. Urethroplasty should no longer be considered a last-resort surgery but rather a reference technique in treating urethral stricture.

Eficacia y seguridad del balón de dilatación uretral Optilume® en la práctica clínica real: análisis multicéntrico en España

IntroductionThe Optilume® paclitaxel-coated urethral dilatation balloon is an alternative to conventional endoscopic treatments that combines mechanical dilatation with local delivery of paclitaxel. ObjectiveTo describe the success rate and analyze the safety of the device in real clinical practice. To evaluate possible predictors of treatment failure. Material and methodsRetrospective multicenter study in patients diagnosed with urethral stricture and treated with an Optilume® balloon in routine clinical practice. Data were collected from flowmetry, questionnaires (PROM and IPSS) and cystoscopy before surgery, and 3, 6 and 12 months after the procedure, according to standard practice. Surgical success was defined as the absence of subsequent urethral manipulation and a Qmax>10ml/s. Results238 patients treated with Optilume® in 12 Spanish hospitals between May 2021 and April 2024 were included in the study. Of these, 156 who had a minimum follow-up of 3 months, were analyzed. Median stricture length: 1.5cm (0.5 - 5.3), mainly in bulbar urethra (87.7%). Of the total, 12.8% of patients had a history of pelvic radiotherapy, and 81.4% had undergone prior urethral manipulation. Postoperative complications were reported in 14.2% of the total. The treatment success rate was 73.8%, with a median follow-up of 8 months (5-12). No predictors of stricture recurrence were identified. Recurrence rates were higher in strictures located in the posterior versus anterior urethra (42.9% vs. 24.6%, p=0.126). No significant differences were observed between patients with and without prior urethral manipulation. ConclusionTreatment with Optilume® has been shown to be safe and effective in short-term routine clinical practice.

Efficacy and safety of Optilume® paclitaxel-coated urethral dilatation balloon in real-life: experience in a Spanish multicenter study

IntroductionThe Optilume® Paclitaxel-coated urethral dilatation balloon is an alternative to conventional endoscopic treatments that combines mechanical dilatation with local delivery of paclitaxel. ObjectiveTo describe the success rate and analyze the safety of the device in real clinical practice. To evaluate possible predictors of treatment failure. Materials and methodsRetrospective multicenter study in patients diagnosed with urethral stricture and treated with an Optilume® balloon in routine clinical practice. Data were collected from flowmetry, questionnaires (PROM and IPSS) and cystoscopy before surgery, and 3, 6 and 12 months after the procedure, according to standard practice. Surgical success was defined as the absence of subsequent urethral manipulation and a Qmax >10 ml/s. Results238 patients treated with Optilume® in 12 Spanish hospitals between May 2021 and April 2024 were included in the study. Of these, 156 who had a minimum follow-up of 3 months, were analyzed. Median stricture length: 1.5 cm (0.5–5.3), mainly in bulbar urethra (87.7%). Of the total, 12.8% of patients had a history of pelvic radiotherapy, and 81.4% had undergone prior urethral manipulation. Postoperative complications were reported in 14.2% of the total. The treatment success rate was 73.8%, with a median follow-up of 8 months (5–12). No predictors of stricture recurrence were identified. Recurrence rates were higher in strictures located in the posterior versus anterior urethra (42.9% vs. 24.6%, p = 0.126). No significant differences were observed between patients with and without prior urethral manipulation. ConclusionTreatment with Optilume® has been shown to be safe and effective in short-term routine clinical practice.

Prostate ductal adenocarcinoma exhibiting a late recurrence in the anterior urethra 13 years post-total prostatectomy: a case report

BackgroundProstate ductal adenocarcinoma, a rare histology observed in 0.4–0.8% of all prostate cancers, is treated similarly to acinar adenocarcinoma but tends to have a higher likelihood of metastasis, recurrence, and poorer prognosis.Case presentationA 73-year-old Asian-Japanese male presented with gross hematuria, with investigations revealing a prostate ductal adenocarcinoma. Subsequent radical prostatectomy indicated a Gleason score of 8 with no lymph node metastasis. Despite initial prostate-specific antigen level reductions post-prostatectomy and salvage radiation therapy due to recurring elevated prostate-specific antigen levels, no recurrence was evident until 13 years later. A tumor in the anterior urethra was identified as metastasis of his prostate ductal adenocarcinoma.ConclusionThis report presents an uncommon case of prostate ductal adenocarcinoma exhibiting a late recurrence in the anterior urethra 13 years post-radical prostatectomy.

Contrast-Enhanced Ultrasound: A Real-Time, Noninvasive, Radiation-Free Method for Intraoperative Male Urethral Fistula Assessment.

To evaluate the feasibility of intraoperative transurethral contrast-enhanced ultrasound for the assessment of male urethral fistulas. Patients in a prospective database who underwent intraoperative two-dimensional ultrasound, transurethral saline-enhanced ultrasound, and contrast-enhanced ultrasound between January 2017 and July 2022 were included. All patients were clinically diagnosed with urethral fistulae (UF) in the outpatient setting based on clinical presentations, traditional two-dimensional ultrasound, and/or other imaging modalities and confirmed during surgical repair. Dynamic videos of the scans were independently analyzed by two experienced ultrasonologists. Thirty-nine patients with an average age of 51 years were included. The UF were located in the anterior urethra in 22 (56.4%) patients and in the bulbar urethra in 14 (63.6%) patients. UF were located in the posterior urethra in 17 (436%) patients and in the prostatic urethra in 13 (76.5%) patients. Contrast-enhanced ultrasonography revealed UF in all patients. In patients with anterior UF, saline-enhanced ultrasound images did not show a UF in 15 (68.2%, 15/22) patients, 13 (86.7%, 13/15) of whom had fistulae with diameters <3 mm. Saline-enhanced ultrasound images did not reveal posterior UF in 13 (76.5%, 13/17) patients. The fistula diameters in eight (61.5%, 8/13) patients were <3 mm. The duration for contrast-enhanced ultrasonography was approximately 3 minutes. The duration for surgical repair was approximately 2 hours. Transurethral contrast-enhanced ultrasound is a real-time, noninvasive, and radiation-free method that allows intraoperative imaging and accurate assessment of male UF. Its sensitivity is higher than that of both two-dimensional ultrasound and transurethral saline-enhanced ultrasound. The location, size, and course of the fistulae can be clearly seen due to greater contrast during contrast-enhanced ultrasound.

Location-specific diagnostic efficiency of photodynamic diagnosis-guided biopsy in bladder mapping biopsies.

Photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumors (TURBT) has emerged as a promising complementary tool to white light (WL) cystoscopy, potentially improving cancer detection and replacing conventional mapping biopsies. This study aimed to investigate the diagnostic accuracy of PDD by anatomical locations in mapping biopsies through lesion-based analysis. PDD and WL findings were prospectively recorded in 102 patients undergoing mapping biopsies and PDD-assisted TURBT using oral 5-aminolevulinic acid. We evaluated 673 specimens collected from flat tumor or normal-looking lesions on WL cystoscopy, after excluding 98 specimens collected from papillary or nodular tumors. Among the 673 lesions, cancer was detected in 110 (16%) by lesion-based analysis. PDD demonstrated significantly higher sensitivity (65.5% vs. 46.4%, p < 0.001) and negative predictive value (92.5% vs. 89.5%, p < 0.001) compared to WL. The sensitivity of PDD findings varied by location: posterior (100%), right (78.6%), dome (73.3%), left (70.6%), trigone (58.8%), bladder neck (41.7%), anterior (40.0%), and prostatic urethra (25.0%). Incorporating targeted biopsies of specific locations (bladder neck, anterior, and prostatic urethra) into the PDD-guided biopsies, regardless of PDD findings, significantly increased the overall sensitivity from 65.5% to 82.7% (p = 0.001). This study first demonstrated the detection rate of location-specific mapping biopsies using PDD, revealing difficulties in accuracy assessment in areas susceptible to tangential fluorescence. While PDD-guided biopsy improves cancer detection compared to WL cystoscopy even for flat tumors or normal-looking lesions, more careful decisions, including mapping biopsies, may be beneficial for an assessment in these tangential areas.

Evaluation of urethral traumas in children: A retrospective analysis

Objectives: This study aimed to evaluate posttraumatic urethral injuries treated at two centers and evaluate the findings in light of the existing literature. Patients and methods: The records of 14 male patients (mean age: 10.2±2.9 years; range, 4 to 13 years) who underwent treatment for urethral trauma between 2010 and 2015 at the first clinic and between 2017 and 2022 at the second clinic were retrospectively analyzed. Variables including age, sex, etiology of trauma, location of urethral injury, presence of associated injuries, surgical interventions performed, and treatment outcomes were systematically assessed. Results: Motor vehicle accidents emerged as the most frequent cause of injury with eight (57.1%) patients. Urethral injuries were observed in seven patients at the bladder neck, six at the posterior urethra, and one at the anterior urethra. Two patients sustained complete injuries, whereas partial injuries were identified in the remaining 12 cases. All patients initially received either a cystofix catheter or a urethral catheter. Two patients underwent open urethroplasty, while internal urethrotomy was performed in 10 patients. Two patients experienced spontaneous recovery without the need for surgical intervention. The patients achieved complete recovery from their initial presentation. Conclusion: Although open repair of urethral injuries may offer a lower risk of recurrence, delayed internal urethrotomy, which is a less invasive approach, should be considered the primary treatment choice in children.

Одноэтапная уретропластика при протяженных стриктурах передней уретры: лоскут или графт?

Introduction. Penile skin flap and oral mucosal graft are most often used for augmentation urethroplasty for extended anterior urethral strictures. It seems relevant to conduct a study comparing augmentation urethroplasty techniques using these donor materials. Materials and methods. The review is based on articles published throughout history in scientific peer-reviewed journals included in the databases PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), Embase (https://www.embase.com/landing), Cochrane Library (https://www.cochranelibrary.com/), Scientific Electronic Library eLibrary.ru (https://elibrary.ru/). The search was performed on the following keywords: «urethral stricture», «anterior urethra», «penile urethra», «bulbous urethra», «urethroplasty», «augmentation urethroplasty», «penile skin flap», «oral mucosa graft». At the first stage, 445 sources were found, of which 17 articles were included in the review. Results. A total of 17 original studies were identified with a comparative analysis between one-stage augmentation urethroplasty techniques using a penile skin flap and an oral mucosal graft for penile and/or bulbous urethral strictures. 7 (41,2%) studies were a randomized controlled trial, 10 (58,8%) studies were a retrospective cohort study. The total number of patients in whom a flap or graft was used across all studies was 1426. A penile skin flap was used in 638 (44,7%) patients, and an oral mucosal graft was used in 788 (55,3%) patients. The success of treatment using a penile skin flap averaged 77,8%, and an oral mucosal graft averaged 83,7%. Conclusions. Penile skin flap and oral mucosal graft, when used for augmentation urethroplasty, can achieve a similar treatment success rate. When assessing the outcome of urethroplasty in cohorts of patients with long-term postoperative follow-up and a relatively large sample size, the best results were characteristic of oral mucosal grafts.

A novel trauma induced urethral stricture in rat model

Urethral stricture (US) is a longstanding disease, while there has not existed a suitable animal model to mimic the condition. We aimed to establish a trauma-induced US animal model to simulate this clinical scenario. A total of 30 rats were equally distributed into two groups, sham and US group. All rats were anesthetized with isoflurane and undergone cystostomy. In the US group, a 2 mm incision was made in the urethra and sutured to induce US. The sham group only make a skin incision on the ventral side of the anterior urethra. 4 weeks later, ultrasound and cystourethrography were performed to evaluate the degree of urethral stricture, pathological examinations were carried out to evaluate the degree of fibrosis. Urodynamic evaluation and mechanical tissue testing were performed to evaluate the bladder function and urethral tissue stiffness. The results showed that the urethral mucosa was disrupted and urethral lumen was stenosed in the US group. Additionally, the US group showed elevated bladder pressure, prolonged micturition intervals and increased tissue stiffness. In conclusion, the rat urethral stricture model induced by trauma provides a closer representation of the real clinical scenario. This model will significantly contribute to advancing research on the mechanisms underlying traumatic urethral stricture.

Single-Cell RNA Sequencing Reveals a Unique Fibroblastic Subset and Immune Disorder in Lichen Sclerosus Urethral Stricture.

Lichen sclerosus urethral stricture disease (LS USD) is a refractory and progressive disease primarily affecting the anterior urethra in males. Various potential etiological factors, such as genetics, autoimmunity, infection, and exposure to infectious urine, have been suggested. However, the accurate etiology of LS in the male urethra remains unclear. In this study, we conducted single-cell RNA sequencing to identify the transcriptional profiles of three patients with LS USD and three patients with non-LS USD. Immunofluorescence was used to confirm the single-cell sequence results. Our study revealed distinct subsets of vein endothelial cells (ECs), smooth muscle cells (SMCs), and fibroblasts (FBs) with high proportions in LS USD, contributing to the tissue microenvironment primarily involved in proinflammatory and immune responses. In particular, FBs displayed a unique subset, Fib7, which is exclusively present in LS USD, and exhibited high expression levels of SAA1 and SAA2. The accumulation of macrophages, along with the dysregulated ratios of M1/M2-like phenotype macrophages, may be engaged in the pathogenesis of LS USD. Through cell-cell communication analysis, we identified significant interactions involving CXCL8/ACKR1 and CCR7/CCL19 in LS USD. Remarkably, Fib7 exhibited exclusive communication with IL-1B macrophages through the SAA1/FPR2 receptor-ligand pair. Our study provides a profound understanding of the tissue microenvironment in LS USD, which may be valuable for understanding the pathogenesis of LS USD.

RISK FACTORS OF URETHRAL STRICTURE: A SYSTEMATIC REVIEW

Background: Urethral stricture in males is a narrowing of the anterior urethra caused by fibrosis and cicatrisation of the urethral mucosa and adjacent spongiosus tissue ("spongiofibrosis"). In the male posterior urethra, there is no spongiosus tissue; therefore, stenosis is the preferred term. Understanding the risk factors of urethral strictures may be amenable to preventive measures resulting in a decrease in disease severity and health care expenditure. Aim: This study aims to summarize and assess the risk factors of urethral stricture through a comprehensive systematic review. Methods: A systematic search strategy was conducted across several electronic reference databases (PubMed, Cochrane Library, Google Scholar) and included articles published between 2013–2023. Duplicate publications, review articles, and incomplete articles were excluded. Results: The databases search identified a total of 16.645 articles (Table 1) and resulted in 16.155 articles after duplicates removed. Of these, 15.955 articles were excluded due to non-original study and titles and abstract not represented the focus of interest; and resulting in 200 articles for screening process. Articles not evaluating the focus of interest and articles in which full-text are not available are excluded, resulting in 15 articles for eligibility criteria. Among them, 10 articles did not give sufficient details about the risk factors of urethral stricture and some did nit differenriate clearly between the risk factors of urethral stricture and recurrence of urethral stricture. Hence, we found 5 appropriate studies included. Conclusion: The risk factors of urethral stricture in this study includes the dose of brachyterapy for prostate cancer patients, lower resection speed of BPH, prolonged operative time, intraoperative urethral mucosa rupture, post-operative continuous infection, the diameter of the instrument, presence of chronic prostatitis in anamnesis, increased volume of the prostate, repeated drainage of the bladder using the urethral catheter, high comorbidity burden, second TURP surgery, history of preoperative catheter insertion, high postoperative WBC, and long postoperative catheterization time.

Urethral Large Hemangioma in a Prepubertal Female Patient – A Case Report

Background: Hemangiomas rarely occur in the urethra, and most reported cases have involved in men and elderly women1-4. The clinical manifestations of urethral hemangiomas include lower urinary tract symptoms, dysuria, hematuria, perineal discomfort, and urethral discharge. There are only a few cases reported in the literature and exact incidence is still not known.1-5 A few case reports and occasional series have described posterior urethral hemangioma presenting as hematuria. We are reporting a rare case of a cavernous hemangioma of the anterior urethra in a prepubertal female who presented in the gynae OPD with bleeding per vagina. J Com Med Col Teachers Asso Jan 2023; 27(1): 42-43

Mechanical Ablation of the Posterior Urethral Valve Omitting Thermal Energy: A Brief Report.

Management of the posterior urethral valve (PUV) is a clinical challenge in pediatric urology. We report the results of a modified valve ablation method without using a pediatric resectoscope and thermal energy. Patients were selected from children with PUV who were referred to the pediatric urology clinic of Shahid Labbafinejad Hospital, Tehran, Iran, and have undergone endoscopic valve ablation surgery between May 2019 to May 2021. Ten male patients with PUV underwent mechanical valve ablation without the use of the conventional pediatric resectoscope, and thermal energy was replaced by a 6F semi-rigid urethroscope and 3Fr ureteral catheter. Patients were assessed both pre-and postoperatively using serum creatinine, urinary tract ultrasound imaging, and voiding cystourethrography. The mean age was 23.88±30.13 months (range= 25 days to 8 years). Four out of 10 patients (40%) had elevated serum creatinine, and seven had unilateral or bilateral hydroureteronephrosis (70%). No major complications were reported according to Clavien-Dindo Classification System. The level of serum creatinine, the grade of hydroureteronephrosis, and the ratio of the prostatic urethra to anterior urethra diameter in postoperative voiding cystourethrography were decreased. A decrease in serum creatinine level occurred in patients after valve ablation, but this decrease was not statistically significant (P=0.059). The decrease in hydroureteronephrosis grade on the right (P=0.006) and left (P=0.022) was statistically significant. There was no evidence of urethral stenosis or need for repeating resection. It can be concluded that our mechanical valve ablation method might be a safe and effective technique for PUV ablation.

Buccal mucosa substitution urethroplasty

Objective: We present our experience of buccal mucosa substitution urethroplasty in all segments of the Anterior urethra, as the buccal mucosal graft (BMG) is now recognized as the tissue of choice for single-stage reconstruction of bulbar urethral strictures. Patients and methods: Twenty-five patients underwent BMG substitution urethroplasty at our center between January 2015 and January 2019: 18 underwent a single-stage dorsal on lay BMG urethroplasty (pendulous, bulbous), 2 underwent a single-stage ventral onlay BMG urethroplasty (1 pendulous, 1 bulbous), 2 underwent an inlay buccal mucosa grafting (pendulous) followed by tabularization for six months. Results in terms of recurrence, comorbidities, and aesthetics were evaluated. Results: In six months follow-up period, 23 (88%) patients with a one-stage reconstruction remained stricture-free. One patient experienced a recurrence after 3 months and was treated with a one-stage optical urethrotomy, and another patient developed an urethro-cutaneous fistula and was treated with clean, self-intermittent catheterization once a day for 1 month, then twice a week for 3 months. Conclusion: When the anterior urethra is affected by a stricture, a BMG urethroplasty performed in a single stage is highly effective.

War-related urethral and penile injuries' management and short-term outcomes: Experience from war in Yemen

Abstract Objectives To investigate the mechanisms of injury, wound patterns, surgical management, and outcomes of urethral and penile injuries caused by firearms and explosives during the ongoing war in Yemen. Materials and methods The present prospective descriptive study included 46 patients who sustained penile and/or urethral injuries during the ongoing Yemeni war. The patients received primary surgical care in Yemen and were referred for definitive treatment in Egypt between October 2018 and October 2020. Patient demographics, cause of injury, site and severity of injury, and associated injuries were evaluated together with management outcomes. Results The median age was 28 years (range, 18–50 years); 27 patients (58.7%) had posterior urethral injuries, 11 (23.9%) of whom had posterior urethral distraction defect injuries, 5 (10.9%) had a posterior urethral distraction defect injuries associated with urethrorectal fistulas, and the remaining 11 patients developed posterior urethral strictures; 9 patients (19.6%) sustained anterior urethral injuries, and 10 (21.7%) had isolated penile tissue injuries. Injuries to the penis (90%) and anterior urethra (67%) were primarily due to improvised explosive devices, whereas injuries to the posterior urethra (85%) were mostly caused by firearms. During the posttreatment follow-up period (6–12 months), 4 patients (8.7%) developed recurrent urethral strictures. Conclusions Urethral injuries caused by firearms and improvised explosive devices showed a greater association with urethrorectal fistulas or penile tissue injuries than what is typically observed in our practice. Management of these injuries by highly experienced urologists enhances patient outcomes and minimizes future complications.

Idiopathic urethral stricture in adolescents: A case series presentation and review of the literature

Objective: To present our case series of idiopathic urethral stricture in adolescents, analyzing the treatments applied and the results obtained. Methods: A retrospective study of 7 patients with idiopathic urethral stricture treated at our center between 2000 and 2021 was performed. Results: The average age at the moment of surgery was 14.7 years. In 85% of cases the main symptom was voiding difficulty. The diagnosis was by voiding cystourethrography (VCUG) in five patients and by cystoscopy in two, locating the stricture in the anterior urethra in all cases. Six patients were treated with endoscopic urethrotomy and one with balloon dilation. Two patients recurred. The subsequent treatment in both cases was a second endoscopic urethrotomy and one of them required a posterior urethroplasty. Currently 6 out of 7 patients are asymptomatic and the patient who underwent urethroplasty is undergoing regular dilations. Limitations: The number of patients is limited due to the shortage of this pathology in childhood. Value: The available literature is quite limited. It is usually secondary to trauma or surgical interventions such as hypospadias repair. Idiopathic etiology represents less than a third of urethral strictures in adolescents and it causes the greatest controversy regarding its management. Conclusions: We should suspect idiopathic urethral stricture in childhood when symptoms appear, such as voiding difficulty in patients without previous pathologies. VCUG can help diagnosis, but a cystoscopy allows diagnosis and treatment at the same time. Endoscopic urethrotomy should be the treatment of choice for idiopathic strictures smaller than 1 cm, since the success rate is greater than 85%.

Urethral strictures. Diagnosis and treatment

Urethral strictures represent the intrinsic and permanent narrowing of the urethral lumen with urodynamic effects and genitourinary complications resulting from obstruction in the path of urine and seminal fluid elimination. In men, urethral stricture refers to a narrowed segment of the anterior urethra caused by a process of fibrosis and scarring of the urethral mucosa and surrounding spongiosum tissue ("spongiofibrosis"). In the male posterior urethra, there is no spongiosum tissue, and the term stenosis is preferred in this location. The definition of meatal stenosis is accepted as a distal narrowing at the level of the meatus, without involving the navicular fossa. There is no universal definition of female urethral stricture. Female urethral stricture is defined by most authors as "a fixed anatomical narrowing" that leads to a reduction in urethral caliber. This reduced urethral caliber is defined as being between &lt;10 Fr and &lt;20 Fr, with most studies defining it as &lt;14 Fr, compared to the normal urethral caliber of 18-30 Fr. In transgender patients, the term stricture is used to define narrowing of the reconstructed urethra despite the absence of spongiosum tissue around it.[1] In men, a marked increase in incidence is observed after the age of 55, with a median age of 45.1 years. The estimated incidence is generally 229-627 cases per 100,000 men [2]. The anterior urethra is most commonly affected (92.2%), especially the bulbar urethra (46.9%) [3]. In women, 2-29% of patients with refractory lower urinary tract symptoms have obstructive flow at the level of the bladder, of which 4-20% will have urethral strictures [4]. There is a significantly increased incidence in women over 64 years of age. In children, most strictures are traumatic: iatrogenic causes account for 27.8-48% and external trauma for 34-72% of cases [1]. Congenital (13%), inflammatory (4%), or postinfectious (1%) strictures are less commonly observed. The bulbar urethra is the most frequently affected part of the urethra [1]. After hypospadias repair, meatal stenosis and urethral strictures are reported in 1.3-20% of cases, depending on the severity of hypospadias and the technique used [5]. There is a significantly higher incidence of this type of stricture in resource-rich countries due to a higher rate of surgical interventions. It has been reported that up to 18% of urethral strictures involving the meatus or navicular fossa are caused by surgical repair of hypospadias, lichen sclerosus, instrumental/traumatic causes, or idiopathic causes. Post-circumcision meatal stenosis has been reported in less than 0.2% of infants undergoing circumcision. In transgender patients ("trans men"), approximately 51% will suffer from a urethral stricture, while in "trans women" (male to female), the incidence is 14.4% [6].

PD35-07 DYNAMIC MRI URETHROGRAM: A NEW FRONTIER IN URETHRAL STRICTURE EVALUATION

You have accessJournal of UrologyCME1 Apr 2023PD35-07 DYNAMIC MRI URETHROGRAM: A NEW FRONTIER IN URETHRAL STRICTURE EVALUATION André Cavalcanti, Rafael Cobo, Gabriel Affonso, and Felipe Da Silva André CavalcantiAndré Cavalcanti More articles by this author , Rafael CoboRafael Cobo More articles by this author , Gabriel AffonsoGabriel Affonso More articles by this author , and Felipe Da SilvaFelipe Da Silva More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The urethral stricture is a disease that cause severe impact on the quality of life in male patients. As a disease were the definitive treatment is a surgical procedure, an adequate pre-operative image study for the surgical planning is essencial. The Retrograde Urethrogram has been the gold standard method for the urethral stricture evaluation during the paste decades. This method has limitations as technical points associated to failures to a precise measure of the stricture length/localization and the incapacity to evaluate the peri-urethral fibrosis. The objective of this study is to test the Dynamic MRI Urethrogram as a unique method to urethral stricture diagnostic and pre-operative evaluation. METHODS: A Group of 25 consecutive patients with a suspicion of urethral stricture disease were submitted to a Dynamic MRI Urethrogram as the unique image study to confirm the diagnosis, disease characterization and surgical planning. All patients were submitted to the same MRI protocol: peripheral venous access and hydration with at least 500 ml of saline solution to stimulate diuresis, installation of 20 ml to 40 ml of lidocaine gel through the meatus, noosing the balanoprepucial sulcus with a sterile gauze. After, routine sequences were performed: Axial T1w, Axial and Sagittal T2, SPACE coronal, MIP Sagittal, T2 Urographic effects techniques images obtained during rest and miccional strain, T1 FS Sagittal before and after gadolinium. All patients were submitted to a urethral reconstruction performed by the same surgeon: anastomotic urethroplasty in 16 patients (64%) and substitution urethroplasty with buccal mucosa graft in 9 patients (36%). RESULTS: In The Dynamic MRI Urethrogram was considered adequate for the definition of surgical proposal in all patients. A diagnostic of anterior urethra strictures was observed in 12 patients (48%) and posterior urethra strictures in 13 patients (53%). The surgeon observed a correspondence between MRI images and surgical findings regarding the location and length of the stricture in all patients. The Dynamic MRI Urethrogram was also adequate to evaluate the urethral caliber in the site of the stricture and the peri-urethral fibrosis. An advantage observed with the use of this method was the possibility to evaluate other organs, structures and the relation with the urethra and the stricture area as rectum, prostate and pubis. The Dynamic MRI Urethrogram also gives the possibility of 3 D reconstructions. CONCLUSIONS: The Dynamic MRI Urethrogram is an excellent method to evaluate the urethral stricture in different portions such anterior and posterior urethra with possible advantages over other methods as the precision measure of location, length, caliber and also evaluation of peri-urethral fibrose and relation with other organ and structures. All those characteristics are important to the surgical planning, specially using a unique image method. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e977 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information André Cavalcanti More articles by this author Rafael Cobo More articles by this author Gabriel Affonso More articles by this author Felipe Da Silva More articles by this author Expand All Advertisement PDF downloadLoading ...

Observational study on histopathology of male anterior urethral stricture: Toward better understanding of stricture pathophysiology

Background: Stricture urethra is generally limited to anterior urethra. At present, there are only a few studies which focus exclusively on the histopathology of stricture urethra disease. Aims and Objectives: The aims of this study were to assess the urethral stricture pathology specimens for determining the severity of chronic inflammation and characteristics of stricture, demographics, and patient-reported outcome measures in patients with inflammatory and non-inflammatory strictures. Materials and Methods: This was a prospective and observational study done on 60 male patients of anterior urethral stricture disease who underwent excision biopsy of stricture during urethroplasty. Pre-operative urinary symptoms assessment was done with a questionnaire provided to all patients and data maintained to assess patient-reported outcomes in inflammatory and non-inflammatory stricture urethra. Cohorts comprising strictures with no inflammation, mild, and moderate to severe inflammation were developed and stricture, the patient characteristics were compared. Results: In a total of 60 histopathological stricture specimens, there was no inflammation in 40%, mild and moderate inflammation was in 28% and 3.3%, respectively. Lichen sclerosis-related strictures had moderate to severe inflammation and most of the strictures were in bulbar urethra (51.6%). Patients with BXO changes showed more inflammation. In patients with inflammatory strictures, hesitancy, straining, and stream were statistically more compared to non-inflammatory strictures. Idiopathic is the most predominant etiology for stricture which showed no inflammation. Conclusion: Histopathological analysis of urethral stricture showed significant tissue heterogeneity in clinically similar strictures. Chronic inflammation was commonly found in stricture specimens indicating active antigen presentation for underlying pathology and patients with inflammatory strictures reported worse health outcomes.