Anterior Urethral Strictures Research Articles

This Month in Adult Urology

This Month in Adult Urology

Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Strictures: A Retrospective Study of Mid and Long-term Outcomes

Introduction: Dorsal onlay urethroplasty with Buccal Mucosal Graft (BMG) is the single stage procedure and is most commonly used to treat long segment anterior urethral strictures. Unilateral mobilisation of the urethra prevents both chordee and ischaemia. Aim: To evaluate the feasibility, medium-term and long-term outcomes of dorsal onlay BMGs when used to treat long anterior segment penile urethral stricture with unilateral mobilisation of the urethra. Materials and Methods: A retrospective study was conducted in Kasturba Hospital, Manipal, Karnataka, India, from January 2008-December 2018. A total of 56 patients with long anterior segment penile urethral strictures underwent BMG substitution for urethroplasty, with a follow-up period ranging from 1.2-10 years. The outcome of the procedure was assessed through clinical history and physical examination, uroflowmetry, retrograde and voiding cystourethrography and urethroscopy {6 French gauge (Fr)}. Statistical analysis was performed using the mean and median. Results: The mean age of 56 patients was 51.8±9.9 years, with a mean±Standard Deviation (SD) Maximum Flow Rate (MFR) of 20.1±5.3 mL at one month and 18.1±4.3 mL at three and 18.7±3.7 mL six months, 17.3±5.1 mL, 19.3±4.3 mL and 18.6±3.7 mL at one year, 2-5 years and 10 years postoperative respectively. Postvoid Residual urine (PVR) volume was higher till one year follow-up (i.e., 1st month it was 38.6±23.6 mL in 47 patients, 3rd month it was 45.8±22.4 mL in 12 patients, 6th month it was 49.0±28.8 mL in 14 patients and one year follow-up it was 43.9±30.8 mL in 24 patients). Minimal complications were noted over 5-10 years follow-up. Conclusion: For long segment anterior penile urethral strictures, unilateral mobilisation in BMG urethroplasty had shown success over both medium and long-term periods.

Clinical Study of Single Stage Dorsolateral Onlay Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

1.1. Objectives: To evaluate the results of dorsolateral onlay buccal mucosal graft (BMG) urethroplasty in various types of long segment anterior urethral stricture. 1.2. Materials and Methods: This is a prospective study, conducted in the Department of Urology, Medical College, Kolkata and Burdwan Medical College, Burdwan from April 2017 to March 2021. Forty patients with long segment (more than 1.5 cm) anterior urethral stricture who underwent substitution urethroplasty using dorsolateral onlay BMG urethroplasty were evaluated with detailed history, physical examination, ultrasonography of KUB with PVRU, uroflowmetry, retrograde urethrography and voiding cystourethrography, sono-urethrograms and cystoscopy. After treatment with dorsolateral onlay BMG urethroplasty, they were followed-up with uroflowmetry at 3 monthly interval for one year and RGU and/or urethroscopy if indicated. Success was defined as normal voiding pattern without any intervention post-operatively. 1.3. Results: With nineteen of the forty cases (47.5%), lichen sclerosus formed the single most common etiology. Panurethral strictures were more common. Out of total 40 cases, 33 (82.5%) had successful outcome and 7 (17.5%) were failure. 1.4. Conclusion: We conclude that it is a simple, technically feasible, easily adoptable and finally successful procedure

Correlation of Sonourethrography Findings of Male Anterior Urethral Stricture with Retrograde Urethrography

Introduction: Imaging plays significant role in diagnosing the male urethral stricture and helps the urologist in determining the treatment protocols. Retrograde urethrography (RGU) had been the standard imaging technique for anterior urethral stricture. Sonourethrography (SUG) as compared to the retrograde urethrography has the advantage of being radiation free. Aim of this study was to compare the sonourethrography findings in anterior urethral stricture with that of retrograde urethrography. Methods: This was an observational study done in 46 patients with clinical symptoms related to lower urinary tract during the period of September 2019 to August 2020 after obtaining informed consent. Ethical clearance was received from Institutional Review Committee, Institute of Medicine. Patients were first evaluated by sonourethrography. Then, retrograde urethrography was done as per the standard protocol of the department. Data were collected in the predesignated proforma including the study variables on sonourethrography and retrograde urethrography and entered in IBM SPSS version 20. The lengths of strictures on sonourethrography and retrograde urethrography were compared. Results: Among 46 patients 21 patients showed anterior urethral strictures on both SUG and RGU with bulbar region as the commonest location. SUG showed all the urethral strictures seen on RGU with significant positive correlation. SUG also showed spongiofibrosis in nine patients. Conclusion: Sonourethrography, an radiation free imaging technique, showed all the strictures seen in retrograde urethrography with added benefit of detection of spongiofibrosis as well.

Laser vs optical urethrotomy for urethral stricture

A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen. As the constriction increases, obstruction occurs and leads to symptoms which may be related to the obstruction or secondary to it(1). (Figure 1). The term stricture usually used for constrictions of the anterior urethra. Otherwise in the posterior urethra the terms stenosis or contracture are applied(2). The site and the age of the patient may give a hint about the cause of the stricture. For example, Meatal strictures may be caused by lichen sclerosis (the most common identifiable cause of anterior urethral stricture in young adults), and instrumentation or poor hygiene at any age(2) A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen. As the constriction increases, obstruction occurs and leads to symptoms which may be related to the obstruction or secondary to it(1). (Figure 1). The term stricture usually used for constrictions of the anterior urethra. Otherwise in the posterior urethra the terms stenosis or contracture are applied(2). The site and the age of the patient may give a hint about the cause of the stricture. For example, Meatal strictures may be caused by lichen sclerosis (the most common identifiable cause of anterior urethral stricture in young adults), and instrumentation or poor hygiene at any age(2).

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume® Drug-Coated Balloon for Anterior Urethral Strictures.

The Optilume® drug-coated balloon (DCB) is a urethral dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. The ROBUST III study is a randomized, single-blind trial evaluating the safety and efficacy of the Optilume DCB against endoscopic management of recurrent anterior urethral strictures. Eligible patients were adult males with anterior strictures ≤12Fr in diameter and ≤3 cm in length, at least 2 prior endoscopic treatments, International Prostate Symptom Score ≥11 and maximum flow rate <15 ml per second. A total of 127 subjects were enrolled at 22 sites. The primary study end point was anatomical success (≥14Fr by cystoscopy or calibration) at 6 months. Key secondary end points included freedom from repeat treatment, International Prostatic Symptom Score and peak flow rate. The primary safety end point included freedom from serious device- or procedure-related complications. Baseline characteristics were similar between groups, with subjects having an average of 3.6 prior treatments and average length of 1.7 cm. Anatomical success for Optilume DCB was significantly higher than control at 6 months (75% vs 27%, p <0.001). Freedom from repeat intervention was significantly higher in the Optilume DCB arm. Immediate symptom and urinary flow rate improvement was significant in both groups, with the benefit being more durable in the Optilume DCB group. The most frequent adverse events included urinary tract infection, post-procedural hematuria and dysuria. The results of this randomized controlled trial support that Optilume is safe and superior to standard direct vision internal urethrotomy/dilation for the treatment of recurrent anterior urethral strictures <3 cm in length. The Optilume DCB may serve as an important alternative for men who have had an unsuccessful direct vision internal urethrotomy/dilation but want to avoid or delay urethroplasty.

Buccal mucosal graft urethroplasty for anterior urethral stricture, experience from a low-income country

Background/purposeThis study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, as the first experience in our context.MethodsThis is a prospective hospital-based study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from January 2017 to January 2019.ResultsThe total number of involved patients was 60. The success rate was found to be 90% (n = 54), while 6 (10%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 50 (83.3%) and 2 (3.3%) patients, respectively. late complications occurred as follows 14 (23.3%) patients had UTI, 12 (20%) had wound infections, 8 (13.3%) had changes in ejaculation, and decrease in intensity of orgasm, and 6 (10%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG).ConclusionImprovement of the service in limited resources countries like Sudan and was reflected in the excellent outcome of BMG urethroplasty as treatment of anterior urethral stricture (success rate 90%).

Diagnosis and treatment of anterior urethral strictures in China: an internet-based survey

BackgroundTo investigate the current diagnostic and therapeutic approaches to anterior urethral strictures of Chinese urologists and to compare with developed countries and the American Urologic Association guidelines.MethodsAnonymous questionnaires were distributed to members of Official Wechat Account of urology from March 19, 2020 to April 10, 2020. Descriptive and multiple correspondence analysis were used to analyze the data.ResultsA total of 1276 online questionnaires were received. The response rate was 21.7% (1276/5878). The most common diagnostic methods for anterior urethral stricture were urethrography (90.7%) and urethrocystoscopy (85.4%), while urethral dilation (92.3%) and internal urethrotomy (60.1%) were the main therapeutic procedures. End-to-end urethroplasty (45.2%) was the most common open surgery, followed by skin flap urethroplasty (14.9%) and free graft urethroplasty (12.4%). 76.2% of urologists used urethroplasty only after the failure of minimally invasive surgery (reconstructive ladder treatment strategy). Furthermore, middle-aged or elderly urologists who had attended trainings, had senior practice roles, and who utilized a reconstructive ladder treatment approach were most likely to perform urethroplasties.ConclusionsAnterior urethral stricture treatment in China is still dominated by minimally invasive surgery, with most urologists using the reconstructive ladder treatment strategy. In general, the overall diagnostic and therapeutic strategies were similar between China and developed countries, with some deviations from the American Urologic Association guidelines.

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study

ObjectiveThe objective of the study was to compare the outcome of tunica albuginea urethroplasty (TAU) and buccal mucosa graft (BMG) urethroplasty for anterior urethral stricture. MethodsThirty patients who met the inclusion criteria were randomised into two groups: TAU (Group A) and BMG urethroplasty (Group B). Surgical outcome was evaluated with pre- and post-operative work-up involving retrograde urethrogram, voiding cystourethrogram, uroflowmetry, and urethroscopy. Patients were followed up till 1 year. ResultsMean duration of surgery was statistically significant between two groups (p=0.0005). Maximum urine flow rate was comparable when compared between two groups (p=0.22) but statistically significant when compared pre- and post-operatively (p<0.001). At follow-up of 1 year, the successful outcomes were 80% in Group A and 87% in Group B. A total of five patients who had unsuccessful results required redo urethroplasty. Complications were minimal in both the groups. ConclusionTAU provides outcomes equivalent to those of BMG urethroplasty. TAU has less operative time, easy to perform, and beneficial in patients with poor oral hygiene.

Comparison of two different methods of establishment of canine urethroplasty model: an experimental trial

BackgroundGraft substitute urethroplasty is recommended for patients with long segment anterior urethral stricture. The therapeutic effects of the grafts need to be validated on the animal models. Therefore the aim of this study was to compared the operative time, blood loss, intra- and post- operative complications of two different methods of establishment of canine urethroplasty model.MethodsTwelve Beagle dogs were randomly separated into control and experimental group using a random number table. Six animals in the control group received the conventional urethroplasty, while the other 6 in the experimental group received the modified procedures. Tube cystostomy and urethroplasty were performed in the control group. The cystostomy not the tube cystostomy were performed in the experimental group, and the testes were simultaneously removed with the scrotum. Per- and postoperative outcomes, complications were evaluated.ResultsThe urethroplasty were successfully performed for all dogs and all of these procedures were done by the same surgeon. The median operative time in the control and experimental groups was 186.8 min and 188.7 min respectively. The blood loss in the control and experimental groups was 40.8 ml and 45.8 ml respectively. No intraoperative complications occurred. 3 animals in the control group developed acute urinary retention after the accidental removal of suprapubic bladder tube and the cystostomy was done again. There was no occurrence of urinary retention in the experimental group. 4 animals in the control group developed the perineal hematoma, in which one animal had the urine leakage and incision infection. Perineal hematoma occurred in only one animal in the experimental group.ConclusionThe occurrence of urinary retention and perineal hematoma decreased in the modified group, in which the cystostomy not the tube cystostomy were performed and the testes with the scrotum were simultaneously removed.

Substitution Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Stricture : Our Experience in Dorsolateral Onlay Approach

Background: Currently the most favorable single stage procedure for management of long segment anterior urethral stricture is dorsal onlay technique of urethroplasty. This required circumferential extensive mobilization of the urethra, which might cause ischemia of urethra in addition to chordee. To evaluate the short term outcome of dorsolateral onlay BMG (Buccal Mucosal Graft) urethroplasty by unilateral urethral mobilization for treatment of long segment anterior urethral stricture&#x0D; Materials and methods: A prospective experimental study from January 2016 to December 2018 is carried out in Department of Urology, Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh. Total 32 patients of long segment anterior urethral stricture were treated by dorsolateral onlay BMG urethroplasty by unilateral urethral mobilization. Stricture &gt;2cm were included; RGU, MCU and Uroflowmetry were the mainstay of assessment. Success was defined as maximum flow rate &gt;15 ml/s, normal RGU and/ urethroscopy. Failure considered as presence of obstructive symptoms, Qmax &lt; 15 ml/s, stricture on RGU and any post-operative urethral intervention.&#x0D; Results: Mean stricture length was 48.72mm (Range: 30-77mm) and mean follow up time was 22.4months (Range: 12-40 months). Three patients were found to develop stricture at proximal anastomotic site during follow up and required optical internal urethrotomy and considered as failure. 01 patients developed Surgical Site Infection (SSI) which resolved after regular dressing. Success rate was 90.7%&#x0D; Conclusion: Dorsolateral onlay BMG urethroplasty by unilateral mobilization is feasible, safe and easily adoptable for long segment anterior urethral stricture with good short term outcome.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 14-17

To Compare the Recurrence Rate of Strictures after Internal Optical Urethrotomy with Intralesional Injection of Mitomycin C versus without Mitomycin C Injection in Patients Presenting with Anterior Urethral Stricture

Background: The urethral strictures occurred due to narrowing of urethra. These may occur after an injury or ureteral or excretory system diseases, due to the injury to urothelium or corpus spongiosum that lead to the development of scar tissues. Mitomycin C can be used as chemotherapeutic agent because of its quality of being anti-tumour actions. Aim: To compare the recurrence rate of strictures after internal optical urethrotomy with intralesional injection of Mitomycin C versus without Mitomycin C injection in patients presenting with anterior urethral stricture. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Urology, Lahore General Hospital, Lahore from 5th September 2016 to 5th March 2017. Methodology: Sixty male patients age 18-70 years, diagnosed with anterior (penile and bulbar) urethral stricture up to 2.0cm were included. Patients were randomly divided into two groups; Group A patients were treated with internal optical urethrotomy alone and Group B patients treated with internal optical urethrotomy with intralesional injection of Mitomycin C. After the procedure, an 18F or 20F indwelling catheter left for 7 days. After 6 months, surgical site evaluated and if stricture again developed, then recurrence labeled. Results: The mean age was 39.32±11.38 years, mean duration of stricture was 6.85±3.32 months and the mean stricture size was 1.21±0.45 cm. The recurrence occurred in 18 (30%) patients. Significant difference was noted for recurrence in both groups (p-value&lt;0.05). Conclusion: The recurrence rate with anterior urethral stricture is significantly lower in with Mitomycin C as compared to without Mitomycin C. Keywords: Recurrence, Urethral stricture, Mitomycin C

'Pee'BuSt Trial: A single-centre prospective randomized study comparing functional and anatomic outcomes after augmentation urethroplasty with penile skin graft versus buccal mucosa graft for anterior urethral stricture disease.

PurposeTo assess the surgical outcomes of augmentation urethroplasty (AU) using penile skin graft (PSG) compared to buccal mucosa graft (BMG) in anterior urethral stricture disease.MethodBetween January 2018 and January 2019, 100 patients with anterior urethral stricture planned for AU were randomized into PSG or BMG arms (CTRI/2018/07/015028). Anatomic and functional variables were compared pre-operatively and post-operatively. Primary outcome was success rate at 18 months and it was defined if any of the three criteria were met, i.e. either maximum urinary flow (Qmax) > 15 ml/s or urethral calibration of 16 French or ability to traverse the repair with 17 French cystoscope. Secondary outcomes were functional parameters such as International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) Score, Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EJD), and Urethral Stricture Surgery-Patient Related Outcome Measure (USS-PROM).ResultsPre-operative variables were comparable between both the arms. Median duration of follow-up was 22 months (18–24 months). At 18 months, the success rates of AU with PSG and BMG were comparable (89% v/s 91%; p = 0.70, 95% CI-0.33 to 5.21). The improvements in Qmax (p = 0.06), IPSS (p = 0.43) and USS-PROM (p = 0.49) were comparable between the two arms. There was no statistically significant difference in the IIEF-Erectile domain (p = 0.07), IIEF-Orgasmic domain (p = 0.11) and MSHQ-EJD (p = 0.20) following AU at 18 months. Clavien–Dindo grade I complications were 12.7% in PSG and 16.7% in BMG.ConclusionThis study provides level 1 evidence of no statistical significant difference in outcomes of AU using BMG or PSG.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-021-03843-x.

Impact of urethroplasty on overactive bladder symptoms in patients with anterior urethral strictures.

To investigate the incidence of overactive bladder in men with anterior urethral stricture and to evaluate the impact of urethroplasty on its improvement. A total of 104 men with anterior urethral stricture who underwent urethroplasty between 2016 and 2020 completed a validated urethral stricture surgery patient-reported outcome measure comprising six lower urinary tract symptoms questions on voiding symptoms and overactive bladder symptom score before and 3, 6, and 12 months after urethroplasty. Patients with an urgency score of ≥2 for overactive bladder symptom score question 3, and a total overactive bladder symptom score of ≥3 were considered to have overactive bladder. An improvement in overactive bladder was defined as a decrease in the total overactive bladder symptom score by at least three points. Thirty-nine patients (37.5%) were considered to have overactive bladder, and improvement in overactive bladder after urethroplasty was found in 30 (76.9%). Maximum flow rate on uroflowmetry, postvoid residual urine volume, lower urinary tract symptoms total score, and total overactive bladder symptom score were all significantly improved after urethroplasty (P < 0.0001 for all variables). There was a positive correlation between changes in lower urinary tract symptoms total score and total overactive bladder symptom score (Spearman's correlation 0.48, P < 0.0001). Multivariate logistic regression analysis showed that greater change in lower urinary tract symptoms score was an independent predictor of improvement in overactive bladder (odds ratio 1.30, 95% confidence interval 1.06-1.59; P = 0.002). Overactive bladder is prevalent in patients with anterior urethral stricture, and can be effectively improved after urethroplasty. Improvement of voiding symptoms are key for improving overactive bladder symptoms.

ROLE OF SONOURETHROGRAM IN EVALUATION OF SHORT SEGMENT ANTERIOR URETHRAL STRICTURE

INTRODUCTION: Retrograde urethrography (RGU) is the standard imaging study for the evaluation of anterior male urethra. Sonourethrography(SUG) offers comparable information with added advantages. MATERIAL AND METHODS: 196 males with anterior urethral stricture studied. RGU/MCU, sonourethrogram and urethroscopy done in all and information regarding urethral stricture was compared keeping urethroscopy as gold standard. Strictures &gt; 4 cm were excluded. Chiou et al classication used to classify urethral stricture on SUG. Bulbar urethra was the most common si RESULTS &amp; DISCUSSION: te for urethral stricture. Sensitivity of sonourethrography for location of stricture was &gt;98%. Strength of agreement between SUG and urethroscopy for location of stricture was very good. Number of the strictures were diagnosed with higher accuracy on urethroscopy than SUG and RGU respectively. Kappa value for number of strictures was suggestive of very good agreement between SUG &amp; urethroscopy. Length of stricture in urethroscopy was better correlating with SUG. Both RGU and SUG were equally sensitive in location and number of stricture while RGU correlated poorly in the bulbar urethra, older studies also showing RGU underestimating the length of stricture in bulbar urethra. Sonourethrography also providing additional information regarding periurethral pathologies. The complications encountered during RGU were contrast intravasation, pain during the procedure, urethral bleeding and UTI after the procedure. During sonourethrography no signicant complication noted. CONCLUSIONS: Sonourethrography is a multiplanar, easily available and cost-effective technique for evaluating anterior urethra without radiation exposure. When compared with RGU, sonourethrography is equally efcacious with added important technical advantages which help surgeons to plan surgical procedure.

MP56-20 LONG-TERM OUTCOMES AND COMPLICATIONS OF MODIFIED LINGUAL MUCOSA GRAFT RECONSTRUCTIVE TECHNIQUE FOR ANTERIOR URETHRAL STRICTURE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-20 LONG-TERM OUTCOMES AND COMPLICATIONS OF MODIFIED LINGUAL MUCOSA GRAFT RECONSTRUCTIVE TECHNIQUE FOR ANTERIOR URETHRAL STRICTURE Chao Feng, Yue-min Xu, Ying-long Sa, Jiong Zhang, Hong xie, Chong-rui Jin, Jie-min Si, Lu-jie Song, Kai-le Zhang, and Qiang Fu Chao FengChao Feng More articles by this author , Yue-min XuYue-min Xu More articles by this author , Ying-long SaYing-long Sa More articles by this author , Jiong ZhangJiong Zhang More articles by this author , Hong xieHong xie More articles by this author , Chong-rui JinChong-rui Jin More articles by this author , Jie-min SiJie-min Si More articles by this author , Lu-jie SongLu-jie Song More articles by this author , Kai-le ZhangKai-le Zhang More articles by this author , and Qiang FuQiang Fu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The feasibility and reliability of lingual mucosa graft (LMG) for urethroplasty has been confirmed. In this study, we tried to evaluate the long term results of LMG urethroplasty and to analyze the impact factors for the surgical outcome of LMG reconstruction. METHODS: This retrospective study conclude 105 male patients with anterial urethral strictures. The etiology of strictures included lichen sclerosis, trauma, inflammatory, iatrogenic and idiopathic. Modified lingual mucosa graft harvesting technique was used in all cases. One side dissection dorsal onlay technique (Kulkarni technique) was used for reconstruction. The cases were followed up 6 months, 2 years and 5 years after discharge. RESULTS: The mean follow-up duration was 33.77±19.43 months. The average length of stricture was 7.45±4.22 cm. The average length and width of lingual mucosa graft were 7.13±3.95 cm and 1.50±0.45 cm, respectively. By the 6 months after operation, 77.17% cases were recorded a good result. At the end of 2 years, 80.95% cases still maintained an idea outcome. Within 5 years follow-up, only 7 cases complained about the oral complications since 6 months after the operation. The width and length of graft was not related with surgical outcome and complication. However, age showed the relationship with short term surgical outcome. CONCLUSIONS: The modified lingual mucosa graft reconstructive technique has been proved to be used for various anterior urethral stricture feasibly. For the long-term results, it showed the good outcome and few complications. The age might be the independent impact factors for the short term surgical ooutcome. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e976-e977 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chao Feng More articles by this author Yue-min Xu More articles by this author Ying-long Sa More articles by this author Jiong Zhang More articles by this author Hong xie More articles by this author Chong-rui Jin More articles by this author Jie-min Si More articles by this author Lu-jie Song More articles by this author Kai-le Zhang More articles by this author Qiang Fu More articles by this author Expand All Advertisement Loading ...

MP03-04 LOWER URINARY TRACT SYMPTOM MANAGEMENT TRENDS PRIOR TO REFERRAL FOR URETHROPLASTY FOR ANTERIOR URETHRAL STRICTURE DISEASE FROM A CONTEMPORARY PROSPECTIVE COHORT

INTRODUCTION AND OBJECTIVE:Anterior urethral stricture disease (aUSD) is often a diagnosis of exclusion in men presenting with refractory lower urinary tract symptoms (LUTS). When the stricture is ...

MP56-14 AN 18-YEAR ANALYSIS ASSESSING PREDICTORS OF UNSUCCESSFUL GRAFT TAKE AFTER FIRST-STAGE ORAL MUCOSA GRAFT URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-14 AN 18-YEAR ANALYSIS ASSESSING PREDICTORS OF UNSUCCESSFUL GRAFT TAKE AFTER FIRST-STAGE ORAL MUCOSA GRAFT URETHROPLASTY Ziho Lee, Aaron Stewart, Jolie Shen, Desiree Sanchez, Alexander Skokan, and Judith Hagedorn Ziho LeeZiho Lee More articles by this author , Aaron StewartAaron Stewart More articles by this author , Jolie ShenJolie Shen More articles by this author , Desiree SanchezDesiree Sanchez More articles by this author , Alexander SkokanAlexander Skokan More articles by this author , and Judith HagedornJudith Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Graft take after first-stage oral mucosa graft urethroplasty is an important outcome measure given its implications for technical feasibility and efficacy of multi-stage urethral reconstruction. We review our 18-year experience with first-stage oral mucosa graft urethroplasty, and identify clinical predictors of unsuccessful graft take. METHODS: We retrospectively reviewed all patients who underwent a first-stage oral mucosa graft urethroplasty as part of a planned multi-stage urethral reconstruction from 04/2001-10/2019. In all cases, the oral mucosa graft was fenestrated prior to securing it to the neo-urethral plate with absorbable sutures. The primary outcome measure was unsuccessful graft take, which was assessed between 3 and 12 months postoperatively and defined as an oral mucosa graft plate suboptimal for neo-urethral tubularization. More specifically, patients with unsuccessful graft take included those recommended to undergo repeat first-stage urethroplasty and/or those with <70% graft take. Multivariable logistic regression was utilized to identify clinical predictors of unsuccessful graft take. RESULTS: Of 160 patients who underwent first-stage oral mucosa graft urethroplasty, 32 (20.0%) had unsuccessful graft take. Indications for multi-stage urethroplasty included hypospadias in 55/160 (34.4%) patients, lichen sclerosis in 46/160 (28.8%) patients, trauma in 12/160 (7.5%) patients, and other in 47/160 (29.4%) patients. Within our cohort, 60/160 (37.5%) patients previously underwent at least one failed urethral reconstruction prior to first-stage urethroplasty. Higher body mass index (p=0.020) and positive history of previously failed urethral reconstruction (p=0.011) were independent predictors of unsuccessful graft take. Age at time of surgery (p=0.090), stricture etiology (p=0.691), total area grafted at time of first-stage urethroplasty (p=0.164), history of diabetes (p=0.217), history of cardiovascular disease (p=0.526), and current smoking status (p=0.508) did not predict unsuccessful graft take. CONCLUSIONS: Elevated body mass index and positive history of previously failed urethral reconstruction are associated with unsuccessful graft take after first-stage oral mucosa graft urethroplasty. Patients at risk for unsuccessful graft take after first-stage oral mucosa graft urethroplasty should be appropriately counselled when considering multi-stage urethral reconstruction for complex anterior urethral stricture disease. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e974-e974 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziho Lee More articles by this author Aaron Stewart More articles by this author Jolie Shen More articles by this author Desiree Sanchez More articles by this author Alexander Skokan More articles by this author Judith Hagedorn More articles by this author Expand All Advertisement Loading ...

Evaluation of the efficacy of perineal urethrostomy for patients with anterior urethral stricture: insights from surgical and patient-reported outcomes.

To examine the efficacy of perineal urethrostomy (PU) in patients with anterior urethral stricture. Patients who underwent PU for anterior urethral stricture between 2013 and 2020 were retrospectively reviewed (n = 56). Surgical success was defined as no need for additional intervention. Uroflowmetry and measurement of residual urine volume (PVR) were examined postoperatively, and the patients were asked to fill out sexual health inventory for men (SHIM) and the validated Urethral Stricture Surgery Patient-reported Outcome Measure questionnaires before and after PU. The overall patient satisfaction was also assessed. PU was successful in 92.9% of patients (n = 52), with a median follow-up of 34months. Two of four were salvaged by re-do PU, and one was salvaged by forming a composite stoma using a penile skin graft. Thirty-nine patients (69.6%) filled out the questionnaires 6months after surgery. The mean maximum flow rate, PVR, lower urinary tract symptoms (LUTS)-total score, LUTS-specific quality of life, and EuroQol-visual analog scale scores improved significantly from 3.8mL/s, 77.6mL, 12.9, 2.6, and 53.6 at baseline to 17.6mL/s, 21.3mL, 4.1, 0.9, and 74.9 postoperatively (p = 0.003, p = 0.004, p = 0.005, p < 0.0001, p < 0.0001, respectively). The SHIM score did not change significantly (from 2.6 at baseline to 2.3 postoperatively; p = 0.59). As for patient satisfaction, 84.6% of patients (33/39) were "satisfied" (46.1%) or "very satisfied" (38.5%) with the outcome. PU had a high surgical success rate, and significantly improved patients' subjective symptoms and achieved a high level of satisfaction.

P0403 - Feasibility and outcomes of dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: Follow-up of 60 months from a tertiary care center

P0403 - Feasibility and outcomes of dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: Follow-up of 60 months from a tertiary care center