Augmentation Urethroplasty Research Articles

The effect of closure versus nonclosure of lingual mucosa graft harvest site on postoperative morbidity in augmentation urethroplasty: A comparative study.

Objectives:The objective of this study is to compare postoperative morbidity of closure versus nonclosure of the lingual mucosa graft (LMG) harvest site in augmentation urethroplasty.Materials and Methods:From January 2015 to November 2016, a total of 42 patients who underwent LMG urethroplasty randomized in 2 groups. In Group 1, donor-harvesting site was left open while in Group 2, donor site was closed. Self-made questionnaires were to assess postoperative pain, difficulty in tongue protrusion, swelling and numbness in graft harvest site, speech impairment, and difficulty in tolerating liquid and regular diet.Results:Mean visual analog scales score was 7.1 in Group 1, and 7.9 in Group 2 on day 0, which was statistically significant. Nearly 90.47% of patients in closure group and 95.23% in nonclosure group were able to swallow liquid diet on day 0 (P = 0.5604). On day 3, 95.71% of patients in Group 1 and 80% in Group 2 were able to swallow soft diet (P = 0.1604). Numbness was present in 80.95% Group 1 and 71.42% in Group 2 on day 0, which improved to 28.57% pts in Group 1 and 33.33% in Group 2 on day 3. On day 3, slurring of speech was more frequent in closure group (80%). However, at the end of a week, there was no difference in both groups. Saliva production was significantly increased in Group 1 in the 1st week.Conclusion:Long-term morbidities of closing or nonclosing the LMG donor site are similar, but in short term, there is less pain, less edema, early recovery of tongue movements in nonclosure groups.

Гистопатологическая оценка эволюции трансплантатов слизистой оболочки ротовой полости, используемых для аугментационной уретропластики

The clinical efficiency of oral mucosa grafts used for augmentation urethroplasty has been proven. However, a small number of studies in literature are dedicated to the determination of pathologic changes in grafts during the engraftment in the urethra. to assess the histopathologic evolution of oral mucosa graft used for augmentation urethroplasty. A total of 15 patients aged 19-67 years with penile and combined penile/bulbar urethral strictures of length 3.5-11 cm were undergone to two-staged urethroplasty by Asopa technique. In 9 cases the pathologic study of oral mucosa grafts after sampling (buccal mucosa in 5 cases and lip mucosa in 4 cases) and 6 months after their engraftment in the urethra during the second stage of urethroplasty was performed. In other 6 cases the graft tissue in patients with recurrent stricture that occurred 12-24 months after tubularization and requiring additional intervention was studied. The general structure of mucosal graft was preserved 6 months after sampling. The dystrophic changes in epithelium, inflammatory infiltration and foci of fibrosis in subepithelial layer were observed. Buccal grafts were distinguished by a smaller epithelium thickness and the presence of keratinization foci. The grafts also retained their structure after 12-24 months. A decrease in the severity of chronic inflammatory reaction and the absence of keratinization of the squamous buccal epithelium were found. The stricture in the area of anastomosis was characterized by the presence of sclerotic and fibrous connective tissue covered with urothelium. The oral mucosa grafts completely preserve their histologic structure during 1-2 years and they are not involved in recurrence of urethral stricture, which develops in the area of anastomosis between graft and native urethra.

Хирургическая техника и первые клинические результаты аугментационной анастомотической уретропластики без пересечения спонгиозного тела (операция KODAMA)

In case of complex and long urethral stricture a use of augmentation technique is often limited by "critically" narrowing of urethral plate. In such cases, the augmentation anastomotic urethroplasty without division of the corpus spongiosum can be the method of choice, because it allows to perform simultaneous augmentation urethroplasty with maximal sparing of antegrade blood flow in corpus spongiosum. In urologic clinic of N.I. Pirogov City Clinical Hospital No1 the analysis of 17 patients who were undergone to augmentation anastomotic urethroplasty without division of the corpus spongiosum (Kodama technique), performed by single surgeon from 2013 to 2017 yy was done. The meant stricture length was 3.75 cm (2-6). Penile, bulbar and panurethral stricture was found in 6 (35.3%), 7 (41.2%) and 4 (23.5%) cases, respectively. Technique efficiency was 88.2% and in 2 patients (11.8%) a stricture recurrence developed. The mean maximum flow rate before and after surgery were 5.4 and 23.1 ml/s, respectively (p<0.05). The mean catheterization time was 14 (7-30) days. There were no patients with de novo urinary incontinence and erectile dysfunction. The initial results of augmentation anastomotic urethroplasty without division of the corpus spongiosum showed high efficiency. To our opinion, the antegrade blood flow sparing makes it the method of choice in patients with long non-traumatic urethral stricture (without severe spongiofibrosis), good preoperative erectile function but isolated length of "critically" narrowing of the urethral lumen.

Use of rectal mucosal grafts in substitution urethroplasty: an early series.

BackgroundTo evaluate the feasibility of use of rectal mucosal grafts for augmentation urethroplasty.MethodsA series of five patients who underwent rectal mucosal graft urethroplasty for urethral stricture disease were identified. Descriptive statistics were used to describe these patients. Primary endpoints were recurrence of stricture and perioperative morbidity.ResultsFive patients underwent rectal mucosal graft augmentation urethroplasty. Four had a history of prior buccal mucosal graft (BMG) urethroplasty and one had a history of head and neck cancer. Rectal mucosa was noted to be thinner and required more tailoring than buccal mucosa. All patients had patent urethras at time of postoperative retrograde urethrogram. A small diverticulum was noted in one patient with no further sequelae. No complications from rectal mucosal graft harvest were noted. All patients with prior buccal grafting subjectively preferred the rectal graft due to fewer side effects. Subjectively, patients with prior buccal grafts preferred the post-operative recovery following rectal mucosal graft urethroplasty.ConclusionsRectal mucosal graft augmentation urethroplasty is a safe alternative in patients with contraindications to buccal grafting with limited morbidity.

The Benefits of Using a Small Caliber Ureteroscope in Evaluation and Management of Urethral Stricture.

Introduction and Objective The proper evaluation of urethral strictures is an essential part of the surgical planning in urethral reconstruction. The proper evaluation of the stricture can be challenging in certain situations, especially when the meatus is involved. We propose that the use of a small caliber ureteroscope (4.5 Fr and 6.5 Fr) can offer additional help and use for the surgical planning in urethroplasty. Methods We prospectively collected data on 76 patients who underwent urethroplasties in Kulkarni Reconstructive Urology Center, Pune, India and Thunder Bay Regional Health Sciences Center, Thunder Bay, Canada. Patients had retrograde and micturition urethrograms performed preoperatively. The stricture was assessed visually using a 6.5 Fr ureteroscope. If the stricture was smaller than 6.5 Fr, we attempted using the 4.5 Fr ureteroscope. In nonobliterated strictures, we attempted bypassing the stricture making sure not to dilate the stricture. A glide wire would be passed to the bladder under vision. Stricture length, tissue quality, presence of other proximal strictures, false passages, and bladder tumors or stones would be assessed visually. If the penile stricture was near obliterative (smaller than 4.5 Fr caliber), a two-staged procedure is elected to be performed. For proximal bulbar strictures, if the urethral caliber is less than 4.5 Fr and the stricture length is less than 1 cm, we perform a nontransecting anastomotic urethroplasty (NTAU). If the stricture length is >1 cm, we perform a double-face augmented urethroplasty (DFAU). If the urethral caliber is >4.5 Fr and particularly those who are sexually active, ventral inlay with buccal mucosal grafts (BMGs) is performed. In mid to distal bulbar strictures, if the urethral caliber is >4.5 Fr, our procedure of choice is dorsal onlay with BMG. For those with urethral caliber <4.5 Fr and a stricture less than 1 cm, we perform a NTAU. For strictures longer than 1 cm, we perform a DFAU. With the exception of trauma, we very rarely transect the urethra. For panurethral strictures, we almost exclusively perform Kulkarni one-sided dissection. Results Urethroscopy was performed in 76 patients who presented for urethroplasty from July 2014 to September 2014 (in Pune) and between April 2016 and September 2017 (in Thunder Bay). Bypassing the stricture was achieved in 68 patients (89%) while it was unsuccessful in 8 patients (11%). In all unsuccessful urethroscopies, the stricture was near obliterative <4.5 Fr. Our surgical planning changed in (13) 17% of the cases. Out of 43 bulbar strictures, the decision was changed in (9) 21% where we performed 4 DFAU, 3 AAU (augmented anastomotic urethroplasty), and 2 EAU (end anastomotic urethroplasty). In 13 penile strictures, we opted for staged urethroplasty including 3 Johansons and 1 first-stage Asopa in 30.7%. In 20 panurethral urethroplasties, 1 patient (5%) had a urethral stone found in a proximal portion of the bulbar urethra distal to a stricture ring that was removed using an endoscopic grasper. Conclusion The use of the small caliber ureteroscope can help in evaluation of the stricture caliber, length, and tissue quality. The scope can also aid in placing a guide wire, evaluating the posterior urethra, and screening for urethral or bladder stones. It can also improve the preoperative patient counselling and avoid unwanted surprises.

Заместительная уретропластика слизистой ротовой полости у пациента с протяженной стриктурой уретры

Urethral strictures are one of the most common reasons to see a urologist and are considered a socially significant disease. Management of urethral strictures is one of the challenging issues in urology. The article presents a case of a patient with extensive iatrogenic stricture of the penile urethra. The patient underwent penile augmentation urethroplasty using buccal mucosa resulting in the restoration of the whole length of the urethral lumen and non-obstructive urination according to uroflowmetry findings.

Analysis of the donor site complications after long-strip lingual mucosal graft for the treatment of long-segment anterior urethral strictures in males

Objective To analyze the donor site complications of male patients with long segment anterior urethral strictures that underwent urethroplasty by using a long-strip lingual mucosal grafts (LMG) six months later. Methods Between August 2006 and December 2014, a total of 81 patients with long segment anterior urethral stricture underwent a procedure of urethroplasty using a long-strip LMG. The mean patients’ age was 41.2 years (range 18-74) and the mean urethral stricture length was 12.1 cm (range, 8-20 cm), a single LMG was more than 9 cm. Two techniques of urethroplasty were performed: One-sided dorsal graft augmentation urethroplasty was performed in 70 patients, 12 of the 70 patients underwent urethroplasty by using a LMG in addition to a BMG, owing to the presence of very long strictures; Dorsal patch graft urethroplasty was performed in 11 patients. Results Of the 81 patients a single long-strip LMG with length of 9-11 cm was used in 52 patients, LMG measured ≥12 cm in 17, and LMG combined with buccal mucosal graft (BMG) in 12. The mean follow-up period was 41 months (range, 15-86 months) postoperatively. The overall urethroplasty success rate was 82.7%. Six months after the operation, 28 patients (34.6%) reported a minimal to moderate difficulty in fine motor movement of the tongue (difficulty with spitting tiny fish bones). Among these 28, 22 patients (27.2 %) had associated numbness over the donor site, 10 patients (12.3%) had parageusia, and 11 patients (13.6%) reported slurring of speech. The donor site complications occurred higher in patients with LMG length≥12 cm (14/29) than those patients with LMG length<12 cm (14/52)(χ2=19.049, P<0.01). At 12 months, 5 patients (6.2%) reported minimal difficulty in fine motor movement of the tongue, and reduced to 1 patient at 24 months. Conclusions The donor side complications after long-strip lingual mucosal graft for the treatment of long-segment anterior urethral strictures are primarily limited to the first postoperative year, the incidence of complications appeared to be related to the length of the harvested graft. Key words: Lingual mucosa; Complication; Urethral stricture; Urethroplasty

Сравнительный анализ одно- и двухэтапной аугментационной дорсальной INLAY-пластики буккальным графтом протяженных стриктур спонгиозной уретры

Urethral reconstructive surgery is in constant development. At present, reconstructive urethroplasty with buccal mucosa is increasingly being used. The study aimed to compare the results of a one- and two-stage augmentation urethroplasty with dorsal inlay buccal graft for strictures of the spongious urethra. The study comprised 72 patients aged 19-64 with urethral strictures 3-18 cm long. In 34 (47.2%) patients, the stricture was localized in the penile urethra, in 30 patients (41.6%) in the penile-bulbous urethra and in 8 patients (11%) in the bulbous urethra. All patients underwent augmentation urethroplasty with dorsal inlay buccal graft. The results were evaluated separately in 55 (76.4%, group 1) and 17 (23.6%, group 2) patients who underwent one-stage and two-stage surgery, respectively. The incidence rate of early postoperative complications was higher after one-stage (23.6%) compared two-stage surgery (11.8%) (p<0.05). Hematomas, wound dehiscence and urethrocutaneous fistulas were observed only after single-stage surgery. Primary healing of extensive strictures following augmentation urethroplasty with dorsal inlay buccal graft was achieved in 88.9% of patients; treatment effectiveness in the group 1 was 89.1%, in the group 2 - 88.2% (p>0.05). The final effectiveness of the operation, achieved with the use of additional surgical interventions, is estimated at 98.6%. The results of augmentation urethroplasty with dorsal inlay buccal graft do not depend on the number of stages, but fewer complications accompany two-stage surgery.

Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty.

To compare long- term outcomes of buccal mucosa graft (BMG) augmentation urethroplasty for long segment bulbar urethral strictures done by placing the graft ventrally, dorso-laterally and dorsally. We conducted a single institution retrospective study on 112 who underwent BMG augmentation urethroplasty for non-traumatic bulbar urethral strictures between January 2005 to December 2014. The cases were divided into three groups based on the site of placement of BMG graft i.e. (a) Ventral (n=44), (b) Dorso-lateral (n=48) and (c) Dorsal (n=20). Follow-up period was from one year to five years. Patients with failed outcomes underwent urethroscopy or retrograde urethrogram to note the site of recurrence of stricture. Out of 112 cases 91 (81%) were successful and 21 (19%) failed. The success rates for ventral, dorso-lateral and dorsal BMG augmentation procedures were 89%, 79% and 70%, respectively (p=0.18). Among 21 failed cases, 12 cases (57%) had stricture at proximal anastomotic site, 4 cases (19%) at graft and 5 cases (24%) at distal anastomotic site (p=0.01). The overall success rate for BMG augmentation urethroplasty is equal for all techniques. Ventral onlay urethroplasty provides better exposure of proximal anastomotic site thus it is associated with minimum proximal anastomotic site recurrence rates. Patients with extensive spongiofibrosis and long segment strictures had higher rates of failure.

The Impact of Age on Urethroplasty Success

To determine if age is an independent predictor of surgical success in patients undergoing urethroplasty. Urethroplasty performed by excision and primary anastomosis depends on vascular collateralization. Successful augmented urethroplasty depends on graft neovascularization. Older patients have more comorbid conditions including peripheral vascular disease associated with reduced penile blood flow. This is a retrospective review of urethroplasties from 11 institutions. Primary outcome was functional success at 1 year from surgery, defined as freedom from post-urethroplasty procedures. Secondary outcome was freedom from cystoscopic evidence of stricture recurrence at 3 months. Study outcomes were compared between 2 age cohorts (<60 years old and ≥60 years old). Multivariable logistic regression analysis evaluated the influence of patient factors on our primary and secondary outcomes, using age as a continuous variable. Of 322 urethroplasties, 258 were performed in patients <60 years and 64 in patients ≥60 years. Median follow-up was 1.8 years. The following were not significantly different between groups: stricture length or location, smoking status, number of previous urethrotomies or dilations, and urethroplasty type. The following were more common in patients ≥60 years: diabetes, hypertension, hyperlipidemia, coronary artery and peripheral vascular disease, chronic obstructive pulmonary disease, and cancer. There was no difference in need for repeat procedures or anatomic recurrence between age groups or with increasing age. Stricture length was the only statistically significant clinical factor. Urethroplasty success may be affected by comorbidities but not age. Age alone should not be used as an absolute exclusion criterion for men needing urethral reconstruction.

PD34-02 HE LONG-TERM RESULTS OF NON-TRANSECTING BULBAR URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2017PD34-02 HE LONG-TERM RESULTS OF NON-TRANSECTING BULBAR URETHROPLASTY Stacey Frost, Stella Ivaz, Simon Bugeja, Mariya Dragova, Daniela E Andrich, and Anthony R Mundy Stacey FrostStacey Frost More articles by this author , Stella IvazStella Ivaz More articles by this author , Simon BugejaSimon Bugeja More articles by this author , Mariya DragovaMariya Dragova More articles by this author , Daniela E AndrichDaniela E Andrich More articles by this author , and Anthony R MundyAnthony R Mundy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1525AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The non-transecting approach to bulbar urethroplasty was popularised by Jordan et al and Andrich et al and is being used by an increasing number of surgeons. We reviewed our experience with this procedure. METHODS Between January 2009 and December 2015, 125 men with a mean age of 42 (range 16-77) years have undergone a “non-transecting approach” to their bulbar urethral stricture. 112 patients had idiopathic strictures, 5 had iatrogenic strictures, 5 had urethral trauma, 5 were post-radical prostatectomy strictures and 3 were post-TURP strictures. In the same timeframe, 36 transecting anastomotic urethroplasties were performed for straddle injuries and 201 dorsal patch bulbar urethroplasty were performed for long urethral strictures. 58 patients had a non-transecting mucosal anastomotic repair, 48 patients had a non-transecting augmented urethroplasty using buccal graft and 19 underwent a Heineke-Mikulicz-type stricturoplasty alone. All patients underwent clinical assessment and flow rate studies and urethrograms prospectively. RESULTS Clinically, 116 patients (92.8%) were happy with the result of their surgery, 2 were unhappy (but had normal flow rates) and there were 4 failures, who all underwent revisional surgery. 3 patients were lost to follow-up. The mean post-operative peak flow rate was 34.9mls per second, in 102 patients. 7 patients had flow rates of less than 15mls per second, including the 4 failures, 3 patients voided less than 100mls and where therefore not assessable and 13 patients refused a flow rate study or were lost to follow-up (n=3). On antegrade/retrograde urethrogram, 120 were normal, 1 had a slightly reduced calibre but had a normal flow rate, there were 4 recurrent strictures and 9 refused or were lost to follow-up (n=3). Overall 118 of 122 patients (96%) were a success clinically by radiology and flow rate study as well as subjectively. CONCLUSIONS The non-transecting approach to bulbar urethroplasty gives results that are at least as good as previously reported for excision and primary anastomosis or augmented anastomotic urethroplasty or dorsal patch urethroplasty. The increasingly widespread use of this procedure is therefore entirely justified. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e657 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Stacey Frost More articles by this author Stella Ivaz More articles by this author Simon Bugeja More articles by this author Mariya Dragova More articles by this author Daniela E Andrich More articles by this author Anthony R Mundy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Post-Surgical Outcomes of Dorsolateral Onlay Urethroplasty

Background: The standard management of urethral strictures involving the anterior urethra is dorsal onlay buccal mucosa augmentation urethroplasty. This requires circumferential mobilisation of the urethra, which might cause ischemia of the urethra in addition to chordee. In this research, we managed the anterior urethral stricture, applying a dorsolateral onlay urethroplasty.Methodology: This prospective study was conducted in the Department of Urology, BIRDEM General Hospital&amp; some private hospitals from July 2009 to June 2015, the outcomes of a total cases of 103 of one sided anterior dorsolateral onlay OMG Urethroplastywere assess and compared. Patients with anterior and recurrent urethral stricture more than 1 cm were included as study population. Urethrogram and Uroflowmetry were the mainstay of assessment. Success was defined as a maximum flow rate of&gt;20 ml/sec., normal RGU, and/or urethroscopy. Poor outcomes were defined as the presence of obstructive urinary tract symptoms, Qmax &lt;15 ml/sec., stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention.Result: Of the 103 patients, 97 had (94.2%) successful outcome and 6 (5.8%) were failure. Four failed cases underwent optical internal urethrotomy and two patients had persistent narrowing and they were managed by BMG Urethroplasty. Follow up period was 12 months on an average. In conclusion, it can be said thatthe preservation of one sided vascular supply to the urethra and its entire muscular and neurogenic support represent significantly towards perfecting the surgical technique of urethral reconstruction using a minimally invasive approach.Conclusion: In this study, we found it to be a technically feasible, easily adoptable and finally successful procedure.Anwer Khan Modern Medical College Journal Vol. 7, No. 2: Jul 2016, P 16-19

Analyse des taux de succès des urétroplasties pour sténoses de l’urètre bulbaire chez l’homme adulte : revue systématique de la littérature

The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra. We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required. From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36cm. Overall, 19/20 studies used buccal mucosal graft. The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture.

A Novel Experimental Method for Penile Augmentation Urethroplasty With a Combination of Buccal Mucosa and Amniotic Membrane in a Rabbit Model

To investigate the results of penile urethral reconstruction using amniotic membrane (AM) and buccal mucosa (BM) grafts, and the simultaneous use of both in a rabbit model. A total of 28 male rabbits were divided into 4 groups according to grafting style: group 1 (AM), group 2 (BM), group 3 (BM + AM), and group 4 (sham). A standardized urethral defect was created in the 3 initial groups. The sham group underwent only a ventral vertical urethral incision and primary re-suturation. AM grafts were used in group 1, and BM grafts were used in groups 2 and 3. AM grafts were affixed to the BM grafts in group 3 as a covering tissue. Urethrography and endoscopy were performed after the 1st and 2nd months of grafting. The penises were subjected to histopathologic and immunohistochemical assessment for fibroblast growth factor and vascular endothelial growth factor expression. Dehiscence and fistula developed in group 1, whereas 2 fistulas were observed in group 2. No complications developed in group 3. Epithelization at urethras was observed at 4 weeks in all groups, but transformation to urothelial epithelialization occurred at 8 weeks. Marked amelioration and epithelial transformation were observed in group 3. The most prominent fibroblast growth factor expression was observed in group 3. Vascular endothelial growth factor expression was completely negative in group 3 at 8 weeks, indicating complete healing. The simultaneous use of AM and BM for ventral onlay penile urethroplasty provides better tissue healing and lower complication rates in comparison to BM alone. Further animal studies or clinical applications are needed.

Uretroplastia término-terminal para el tratamiento primario de la estenosis de uretra: experiencia del Hospital General Dr. Manuel Gea González

BackgroundUrethral stricture is a urologic disease that has significant morbidity. Direct visual internal urethrotomy is used for the majority of cases in the United States, but end-to-end urethroplasty is the most successful technique. The choice of primary management is controversial. Direct visual internal urethrotomy is widely accepted in the majority of Mexican hospital centers. However, it is reported to have lower long-term success rates. Urethroplasty is indicated for long, densely fibrotic strictures. Diagnosis is based on radiologic studies (nuclear magnetic resonance or ultrasound, with contrast medium). Scales (Urethral Stricture Score) describing stricture complexity are employed to choose surgical treatment. AimsTo communicate the results of primary treatment for urethral stricture in patients at the Hospital General Dr. Manuel Gea González that underwent end-to-end urethroplasty. Materials and MethodsA descriptive study was conducted that reviewed the case records of 210 patients with urethral stricture, selecting the 58 cases that underwent end-to-end urethroplasty as primary treatment within the time frame of January 1, 2007 and December 31, 2013. ResultsThe median age of the patients was 46.4 years. Stricture etiology: traumatic 23%, iatrogenic 58%, idiopathic 17%, and infectious 2%. The most frequent stricture location was at the bulbar level (87.9%) (51), mean length was 2.12cm, 3 cases presented with double-site stricture, 11% (19) of the cases had urinary retention, and the mean urethral stricture score was 5.8. There were 10 recurrences, 9 re-interventions (urinary tract infection), and one augmented urethroplasty. Preoperative Qmax was 5.7-10ml/sec and postoperative Qmax was 13-16ml/sec. Cure was achieved in 82.7% of the cases. ConclusionsUrethroplasty success rates worldwide are reported at 84-97%. Results are related to stricture complexity and surgical experience. There is still no consensus on success parameters. Urethroplasty presents less recurrence compared with direct visual internal urethrotomy, promoting long-term quality of life.

The Selection of Procedures in One-stage Urethroplasty for Treatment of Coexisting Urethral Strictures in Anterior and Posterior Urethra

To explore selection of the procedures in one-stage urethroplasty for treatment of coexisting urethral strictures in the anterior and posterior urethra. Between 2008 and 2014, a total of 27 patients with existing strictures simultaneously at anterior urethra and posterior urethra were treated in our hospital. Two types of procedures were selected for treatment of the anterior urethral strictures. A penile skin flap and the lingual mucosa were used for augmented urethroplasty in 20 and 7 cases, respectively. Three types of procedures, namely, non-transecting end-to-end urethral anastomosis (n = 3), traditional end-to-end urethral anastomosis (n = 17), other grafts substitution urethroplasty, including pedicle scrotal skin urethroplasty (n = 2), and lingual mucosal graft urethroplasty (n = 5), were utilized in the treatment of posterior urethral strictures. The patients were mean followed up 30 months with an overall success rate of 88.9%. The majority of the patients exhibited wide patent urethras on retrograde urethrography and the patients' urinary peak flow ranged from 14.2 to 37.9 ml/s. Complications developed in 3 patients (11.1%). Of the 17 patients who underwent traditional urethral end-to-end anastomosis, urethral strictures occurred in 2 patients at 4 and 6 months after the operation. These patients achieved a satisfactory voiding function after salvage pedicle scrotal skin urethroplasty. A urethral pseudodiverticulum was observed in another patient 9 months after pedicle penile flap urethroplasty; and after a salvage procedure, he regained excellent voiding function. Synchronous anterior and posterior strictures can be successfully reconstructed with a combination of substitution and anastomotic urethroplasty techniques.

1161 Augmented anastomosis versus graft onlay urethroplasty for repair of long bulbar stricture, a prospective comparative study

1161 Augmented anastomosis versus graft onlay urethroplasty for repair of long bulbar stricture, a prospective comparative study

Outcome of buccal mucosa and lingual mucosa graft urethroplasty in the management of urethral strictures: A comparative study.

Objective:The objective of the study was to compare the outcome of buccal and lingual mucosa graft (LMG) augmentation urethroplasty along with donor sites morbidities in anterior urethra stricture.Subjects and Methods:From September 2010 to January 2014, 125 patients underwent single stage augmentation urethroplasty. They were randomly divided into two groups to receive either buccal mucosa graft (BMG) or LMG. The patients were prospectively followed for complications and outcome.Results:Baseline characteristics such as mean age, etiology, stricture length, and location were comparable in both groups. Overall success rate for Group 1 and Group 2 were 69.2% and 80%, respectively. Mean follow-up periods were 28.2 and 25 months in Group 1 and Group 2, respectively.Conclusions:LMG provides the better outcome with fewer immediate and delayed complications as compared to BMG. The length of stricture and width of graft were main factors affecting the outcome.

Bilateral Subconjunctival Hemorrhage: A New Presentation of Stricture Urethra

Bilateral subconjunctival hemorrhage is usually caused by conjunctivitis and trauma. Other causes are straining, sneezing, coughing, or vomiting. We report here two cases of severe stricture urethra who presented to us with bilateral subconjunctival hemorrhage. Both patients had to strain for more than half an hour to empty bladder once, since many months. On evaluation both patients were found to have very narrow segment stricture urethra, underwent subsequent augmented urethroplasty and in about 3 weeks subconjunctival hemorrhage resolved on its own. We conclude that bilateral subconjunctival hemorrhage could be potential presenting sign of stricture urethra in patients who strain severely to empty their bladder.

A Novel Approach to Penile Augmentation Urethroplasty Using Buccal Mucosa and Amniotic Membrane: A Pilot Study in a Rabbit Model

To evaluate and compare the success of amniotic membrane (AM) and buccal mucosa (BM) grafts and simultaneous use of both in penile augmentation urethroplasty in rabbits. A total of 12 New Zealand rabbits were divided into 3 groups by grafting style: Group 1 (AM), Group 2 (BM), and Group 3 (simultaneous use of BM and AM). In all animals, a standardized urethral defect was created. BM and AM were obtained from the rabbits. Solely AM grafts were affixed to the defects in Group 1, solely BM grafts were affixed to the urethral defects in Group 2, and simultaneous AM + BM grafts were affixed in Group 3. At 4 and 8 weeks, the penises were subject to histological assessment of subepithelial fibrosis, epithelial transformation, and inflammatory reaction. Stenosis was detected in none of the groups. A dehiscence was developed in one rabbit in Group 1 and a fistula was developed in one rabbit in Group 2. After 4 weeks, minimal subepithelial fibrosis and inflammatory reaction were observed in Group 2, while subepithelial fibrosis was not in Groups 3. After 8 weeks, subepithelial connective tissue proliferation was moderate in Group 2, at both 4th and 8th weeks in Group 2. After 8 weeks, the best epithelial transformations were observed in Group 3. In an animal model, the simultaneous use of AM and BM grafts following acute urethral injury may be feasible for penile augmentation urethroplasty. Further study is needed.