Average Stricture Length Research Articles

(064) The Optilume® Drug Coated Balloon for Recurrent Anterior Urethral Strictures: Robust III Study 3-year Interim Results

Abstract Introduction The Optilume® Drug Coated Balloon (DCB) is a dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. Outcomes after 3-year follow-up are presented here. Objective The ROBUST III study is a randomized controlled trial comparing the Optilume® Drug Coated Balloon (DCB) against direct visual internal urethrotomy (DVIU) or dilation. Methods 127 subjects were randomized in a 2:1 fashion at 23 sites. Seventy-nine were treated with the DCB and 48 were treated with DVIU or dilation. Follow-up past 1 year was limited to those treated with the DCB. Eligibility criteria included adult males with anterior strictures with ≥2 prior treatments and stricture length ≤3cm. Long-term endpoints included freedom from repeat treatment, International Prostate Symptom Score (IPSS), and peak urinary flow rate (Qmax). Results Subjects randomized to receive the DCB had an average of 3.2 prior treatments and average stricture length of 1.6cm (46% ≥2cm), with 8/79 (10.1%) having penile strictures and 9/79 (11.4%) having prior pelvic radiation. IPSS significantly improved from 22.0 at baseline to 11.3 at 3 years. Qmax significantly improved from a baseline of 7.7 mL/sec to 12.2 mL/sec at 3 years. Freedom from repeat intervention for DCB subjects was estimated to be 74%. No late-onset treatment related adverse events were observed. Conclusions The Optilume® DCB continues to achieve significant improvements in symptoms, flow, and reintervention rates through 3 years post treatment. Disclosure No.

Optilume drug-coated balloon for anterior urethral stricture: 2-year results of the ROBUST III trial.

The aim of this study is to report the updated 2-year results of the intervention arm of the ROBUST III randomized trial evaluating the safety and efficacy of the Optilume drug-coated balloon (DCB) versus standard endoscopic management of recurrent male anterior urethral stricture. Eligible patients included men with recurrent anterior urethral stricture ≤3cm in length and ≤12Fr in diameter, International Prostate Symptom Score (IPSS) ≥11 and peak flow rate (Qmax) <15 mL/s. Patients were randomized to treatment with the Optilume DCB or standard-of-care endoscopic management. Primary efficacy endpoints measured at 2years included freedom from re-intervention and changes in IPSS, Qmax and post-void residual (PVR). Secondary endpoint was impact on sexual function using the International Index of Erectile Function (IIEF). Primary safety endpoint was freedom from serious procedure- or device-related adverse events (AEs). A total of 127 patients enrolled at 22 sites in the United States and Canada (48 randomized to standard-of-care dilation and 79 to DCB dilation). Seventy-five patients in the DCB arm entered the open-label phase after 6 months. Participants averaged 3.2 prior endoscopic interventions (range 2-10); most (89.9%) had bulbar strictures with an average stricture length of 1.63 cm (SD 0.76). Significant improvements in IPSS, average Qmax and PVR were maintained at 2years. Freedom from repeat intervention was significantly higher in the Optilume DCB arm at 2years versus the Control arm at 1year (77.8% vs. 23.6%, p < 0.001). During the follow-up period, there were 15 treatment failures and two non-study-related deaths. Treatment-related AEs were rare and generally self-limited (haematuria, dysuria and urinary tract infection). The Optilume DCB shows sustained improvement in both objective and subjective voiding parameters at 2-year follow-up. Optilume appears to provide a safe and effective endoscopic treatment alternative for short recurrent anterior urethral strictures among men who wish to avoid or delay formal urethroplasty.

Laparoscopic ureteroplasty using onlay appendix flap: a case series

BackgroundCurrently, strictures of the ureters often develop after endourology of the upper urinary tract, gynecological, and surgical interventions. For long proximal ureteral strictures, ureteroplasty with an on-lay appendix flap may be an option for treatment.Case presentationFive patients had laparoscopic onlay appendicoureteroplastic for long right ureter strictures. The average age of the patients was 42.5 years old. Four patients developed a stricture after transurethral contact ureterolithotripsy; one patient had it after laparoscopic ureterolysis. The average stricture length was 3.5 (2.8–5.2) cm. The length of the stricture was controlled, including using near-infrared fluorescence imaging. With an average observation time of 14.6 (6.2–28.4) months, the operation was effective in all patients. The urodynamics of the upper urinary tract recovered completely in three patients and comparatively improved in two patients. All of the patients stopped feeling any pain. The observed patients were saved from external and internal drainage.ConclusionsLaparoscopic onlay ureteroplasty with an appendix in a selected group of patients may be the method of choice for long strictures of the middle and upper parts of the right ureter.

Перинеальная уретростомия: результаты, клинико-статистические и терминологические аспекты

The analysis of the results of perineal urethrostomy for urethral stricture in men for the period from 2000 to 2020 is presented in the article. We identified 29 original articles devoted to this technique, including 4 Russian and 25 foreign publications. In two studies, there were more than 100 patients, four studies included from 51 to 77 men, and in remaining studies less than 50 patients were analyzed. Complete data on all pre- and postoperative aspects of perineal urethrostomy were provided only in a few studies. In the overwhelm of cases, perineal urethrostomy was performed after one or several unsuccessful reconstructive procedures and only in few patients it was done prior to various types of urethroplasty. It was not possible to establish any association between etiological factors and localization of urethral stricture among these patients. The incidence of pan-urethral stricture ranged from 28.6% to 100%. Only in one study the average stricture length was 2 cm, while in all other studies it was 5 cm or more. Postoperative follow-up was on average 14 to 62 months. Treatment success with perineal urethrostomy ranged from 0% to 100%, but in most studies it was 75% or more. The most common perineal urethrostomy technique used included Blandy technique, and Johanson and 7-flap techniques.

Minimizing Antibiotic Use in Urethral Reconstruction.

There are no established guidelines regarding management of antibiotics for patients specifically undergoing urethral reconstruction. Our aim was to minimize antibiotic use by following a standardized protocol in the pre-, peri- and postoperative setting, and adhere to American Urological Association antibiotic guidelines. We hypothesized that prolonged suppressive antibiotics post-urethroplasty does not prevent urinary tract infection and/or wound infection rates. We prospectively treated 900 patients undergoing urethroplasty or perineal urethrostomy at 11 centers over 2 years. The first-year cohort A received prolonged postoperative antibiotics. Year 2, cohort B, did not receive prolonged antibiotics. A standardized protocol following the American Urological Association guidelines for perioperative antibiotics was used. The 30-day postoperative infectious complications were determined. We used chi-square analysis to compare the cohorts, and multivariate logistic regression to identify risk factors. The mean age of participants in both cohorts was 49.7 years old and the average stricture length was 4.09 cm. Overall, the rate of postoperative urinary tract infection and wound infection within 30 days was 5.1% (6.7% in phase 1 vs 3.9% in phase 2, p=0.064) and 3.9% (4.1% in phase 1 vs 3.7% in phase 2, p=0.772), respectively. Multivariate logistic regression analysis of patient characteristics and operative factors did not reveal any factors predictive of postoperative infections. The use of a standardized protocol minimized antibiotic use and demonstrated no benefit to prolonged antibiotic use. There were no identifiable risk factors when considering surgical characteristics. Given the concern of antibiotic over-prescription, we do not recommend prolonged antibiotic use after urethral reconstruction.

Revisiting One-Stage Urethroplasties for Distal Urethral Strictures.

Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7–84.9 years), the mean stricture length was 1.1 cm (0.5–1.5) and the mean follow-up was 42.5 months (28–61.3). Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.

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 ...

Long-term Follow Up of Ileal Ureteral Replacement for Complex Ureteral Strictures: Single Institution Study

ObjectiveTo report our 16-year experience with ileal ureter interposition for complex ureteral stricture. Ureteral reconstruction continues to evolve to include less invasive techniques to successfully manage ureteral stricture. However, long, complex, obliterative and especially radiated ureteral strictures are not amenable to less invasive techniques and may require Ileal ureter interposition. Materials and MethodsRetrospective review of a single institution's ureteral reconstruction database was performed. Demographics, operative details, success rate, complication rate, and length of follow-up were noted. Unilateral replacements utilized ileal ureteral interposition. Success rate was defined as no need for further open intervention. ResultsBetween 2003 and 2019, 188 ureteral reconstructions were performed, of which 46 required ileal ureter interposition. Of these 46 patients, 10 required bilateral reconstruction. Average age was 53 years, 26 (57%) were female. The average stricture length was 9.1 cm (2-20 cm). Stricture etiology included iatrogenic causes (n = 24, 52%), radiation causes (n = 12; 26%), vascular disease (n = 3; 7%), and idiopathic retroperitoneal fibrosis (n = 3; 7%). Forty-three surgeries were performed by open abdominal approach; 3 were performed robotically. The average length of operation was 412 minutes, blood loss 417 mL and LOS was 10 days. At mean follow up of 4.4 years (1-16 years), overall success rate was 83%, with 17% (n = 8) patients requiring subsequent major surgery (5 successful ureteral revision, 3 nephrectomy) and 11 (24%) patients experiencing a major complication. ConclusionIn our long-term follow up of over 4 years, ileal ureteral interposition remains a successful option for complex ureteral strictures in properly selected patients.

PERINEAL URETHROSTOMY: JOURNEY REVISITED

Introduction: Hesitation to offering a perineal urethrostomy to a patient is on the false belief that the satisfaction in regards to urination and sexual performance is low. Method: We have done observational descriptive study and evaluated 50 patients. We included patients between the ages of 40-70 years with urethral stricture diseases and excluded patients who were having PFUD disease and those who have not completed their family. Quality of life is calculated using validated questionnaire by PROM-USS. Results: Most of our patients were in 60-70 years' age group 30/50 i.e. 60%. Most common aetiology of stricture was idiopathic (18) followed by iatrogenic (15), traumatic (9) and post infectious (8). Average length of stricture was more than 6 cm and involving anterior urethra. Patients were followed up for median 14 months. Preoperative IPSS score was 27+/- 4.5 and postoperative was 9+/- 5. SHIM scoring preoperative and postoperative were same ~ 21. PROM-USS for LUTS was signicantly reduced from median of 19 to 8.5 and QOL from median of 5.5 to 2. Success rate with previous urethrotomy, urethroplasty, multiple treatment and no treatment patients were 15/17(88%), 9/12(75%), 11/14(78%), 7/7(100%) respectively. Most of the patients were satised with the procedure. And few of them (3) reported that postejaculatory dysfunction bothering them. In patients in whom second surgery was indicated that is in patients with bladder outlet obstruction the endoscopic procedure was done without any difculty. Conclusions: These reports will likely increase the acceptance of perineal urethrostomy by patients and as well as urologists.

Outcome of Anastomotic Urethroplasty: Single-Center Experience

Objective: To determine the short term outcome of anastomotic urethroplasty. Material and Methods: From January 2013 to June 2015, 25 male patients underwent anastomotic urethroplasty at our center and were analyzed prospectively. Mean age was 28.1 years (range 13-50), average stricture length was 2.5 cm (range 1.5-2.5). Patients with post-prostatectomy stricture, stricture more than 2.5 cm in length or patients of stricture with neurogenic bladder and patients with any perineal disease were excluded from the study. Retrograde urethrogram and voiding cysto-urethrogram was done in every patient to assess stricture length and location. Stricture excision and end-to-end anastomosis of urethra with spatulation was performed in every patient. Minimum followup period was 6 months and maximum 30 months. All patients had obliterative stricture. Results: The mean operative time was 105 min (range 90-120). Four patients (16%) developed complications postoperatively. Wound infection occurred in 01 (04%) patient. Stricture recurrence found in 02 (08%) patients and erectile dysfunction in 01 (04%) patients. Twenty one patients (84%) had excellent outcome, Two (08%) needed optical internal urethrotomy and of them one (04%) failed to respond. Conclusion: Anastomotic urethroplasty has a high success rate of 92%. It is technically straightforward with minimal morbidity. Long term follow-up is strongly recommended for ultimate success. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.38-42

Medical Management of Penile and Urethral Lichen Sclerosus with Topical Clobetasol Improves Long-Term Voiding Symptoms and Quality of Life.

We evaluated the success of minimally invasive management of lichen sclerosus with topical and intraurethral clobetasol, as defined by improvement in patient reported outcome measures and nonprogression to surgery. We conducted a review of our prospective ongoing quality improvement study to determine outcomes of our current standard practice for males with penile and urethral biopsy proven lichen sclerosus. Data were collected between 2011 and 2019, and included patient demographic information, medical and surgical histories, and location and extent of lichen sclerosus related pathology. The primary outcomes for this study were voiding function and voiding related quality of life, and were assessed using the AUASS (American Urological Association Symptom Score) and quality of life bother index, respectively. We identified 42 patients with biopsy proven lichen sclerosus related urethral stricture disease. Of these patients 85.7% were treated with intraurethral steroids alone and did not require surgical intervention. Median AUASS significantly improved from 12 to 8, and median quality of life bother index improved from 4 ("mostly dissatisfied") to 2 ("mostly satisfied"). Average stricture length of those with penile urethral disease and bulbar urethral disease was 4.8 cm (SD 3.0) and 16.2 cm (SD 6.5), respectively. Median followup was 8.4 months (IQR 2.6-26.4). Lichen sclerosus related urethral stricture disease can be effectively managed with intraurethral steroids. This minimally invasive management strategy improves patient reported voiding symptoms and voiding quality of life.

Robotic Surgery for the Reconstruction of Transplant Ureteral Strictures

ObjectiveTo demonstrate the feasibility and success of a robotic approach to reconstruction of ureterovesical anastomotic strictures in kidney transplants. Materials and MethodsBetween November 2017 and December 2019, a total of 5 patients with transplant ureteral stricture were identified and treated with robot assisted laparoscopic repair. All patients were confirmed to have ureteral stricture with a preoperative antegrade nephrostogram through their nephrostomy tube and cystogram. The patients demographics, ureteral characteristics, type of procedure, and outcomes are reported. ResultsAll patients were diagnosed after evaluation for renal deterioration. The average age of the patients was 49 years old. The average stricture length was 2.5 cm, and the location was variable, though more commonly in the distal ureter. Three patients required a pyelo-vesicostomy, while 2 required a ureteroneocystostomy. The mean length of stay was 2.2 days. Average follow-up was 97 days, with all 5 patients having successful outcomes, no strictures or delayed leaks were identified. There were no wound infections or readmissions within 30 days. ConclusionThough a complex repair, the robot-assisted approach to transplant ureter reconstruction using either an end to side neoureterocystotomy or direct pyelo-vesicotomy is technically feasible and successful. Given the many advantages inherent in comparison to an open approach, the robotic repair offers significant advantages to both the patient and the surgeon who is experienced with robotic surgery and reconstructive principles.

MP35-07 ANTIBIOTIC USAGE IN URETHROPLASTIES

INTRODUCTION AND OBJECTIVE: There are no established guidelines regarding management of antibiotics for patients specifically undergoing urethroplasty, which has resulted in significant variation in practice with type, duration, and timing of antibiotic usage. Our aim was to minimize antibiotic use by following a standardized protocol in the pre, peri and post-operative setting and adhere to AUA antibiotic guidelines for urethroplasty. We hypothesized that the common practice of prolonged suppressive antibiotics post urethroplasty does not prevent UTI and/or wound infection rates. METHODS: We prospectively treated 900 patients undergoing urethroplasty at 11 centers over 2 years. A standardized protocol followed the AUA guidelines recommendation for peri-operative cephalosporins eliminating the over use of more board spectrum antibiotics. Phase 1 of our study assessed current practice patterns amongst surgeons in the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) and established a baseline UTI and wound infection rates on suppressive antibiotics. Phase 2 eliminated prolonged post-operative suppressive antibiotics. Antibiotics were given at catheter removal. 30-day infectious complications were determined and a chi-square analysis was used to compare the two cohorts. A standardized definition of UTI and wound infection was utilized. Multivariate logistic regression was performed to identify risk factors. RESULTS: The mean age of participants in both cohorts was 49.7 years old, mean BMI was 30.8, and the average stricture length was 4.09 cm. Overall, the rate of postoperative UTI and wound infection within 30 days was 5.1% (6.7% in phase 1 vs 3.9% in phase 2 (p=0.064), and 3.9%, (4.1% vs 3.7% p=0.772) respectively. After comparing several patient factors including comorbidities, location of stricture, and graft use, only preoperative UTI was a significant predictor of postoperative UTI (p=0.043). No characteristic was significant for wound infections. CONCLUSIONS: The usage of prolonged postoperative antibiotics did not decrease postoperative UTI or wound infection rates. A standardized protocol minimized antibiotic use in the pre, peri and post-operative setting. Given the worldwide crisis of antibiotic overuse, standardized protocols can minimize antibiotic use in urethral reconstruction and post-operative suppressive antibiotics can be eliminated. Source of Funding: none

MP41-20 ILEAL URETER REPLACEMENT FOR COMPLEX URETERAL RECONSTRUCTION HAS A HIGH SUCCESS RATE AT 3 YEAR FOLLOW UP

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-20 ILEAL URETER REPLACEMENT FOR COMPLEX URETERAL RECONSTRUCTION HAS A HIGH SUCCESS RATE AT 3 YEAR FOLLOW UP Bryn Launer*, David Koslov, Kirk Redger, Anessa Sax-Bolder, Ty Higuchi, and Brian Flynn Bryn Launer*Bryn Launer* More articles by this author , David KoslovDavid Koslov More articles by this author , Kirk RedgerKirk Redger More articles by this author , Anessa Sax-BolderAnessa Sax-Bolder More articles by this author , Ty HiguchiTy Higuchi More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Complex or lengthy ureteral strictures may require ileal ureter interposition, which remains an important option for ureteral reconstruction. Reported long term success rate is 75-85%. We report on our 16 year institutional experience with ileal ureter interposition. METHODS: Retrospective review of a single institution’s ureteral reconstruction database was performed. Three urologic surgeons performed all surgeries. Unilateral replacements utilized ureteral interposition when possible. Bilateral ileal ureters were performed using the “reverse 7” approach. Preoperative patient demographics, ureteral stricture characteristics, intraoperative variables, complications, and secondary procedures were recorded. Success rate was defined as no need for further intervention. RESULTS: Between 2003 and 2019, 188 ureteral reconstructions were performed, of which 46 required ileal ureter interposition. Of these 46 patients, 10 required bilateral reconstruction. Average age at the time of surgery was 53 years, and 20 (44%) of the cohort were male. The average stricture length was 9.1 cm. Stricture etiology included iatrogenic causes (n=24, 52%), radiation (n=12; 26%), vascular disease (n=3; 7%), idiopathic retroperitoneal fibrosis (n=3; 7%), and other causes including congenital and trauma (n=4; 9%). Half (n=23) of the cohort received prior intervention for the strictures, and all required prior stent or nephrostomy tube. Forty-three surgeries were performed by open abdominal approach and 3 were performed robotically. The average length of operation was 412 minutes, blood loss=417 mLs, LOS=10 days. Although 23 (50%) patients had a complication, with only 11 (24%) patients experiencing a major (Clavien Dindo ≥ 3a) complication. At a mean follow up of 3.3 years, the overall success rate was 83%, with only 17% (n=8) patients requiring subsequent procedures. Three of the 8 patients required a nephrectomy due to persistent UTIs and pain, while the remaining 5 underwent successful ileal ureteral revision. CONCLUSIONS: In our long-term follow up of over 3 years, ileal ureter interposition is a highly successful option for complex ureteral strictures in properly selected patients. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e602-e602 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bryn Launer* More articles by this author David Koslov More articles by this author Kirk Redger More articles by this author Anessa Sax-Bolder More articles by this author Ty Higuchi More articles by this author Brian Flynn More articles by this author Expand All Advertisement Loading ...

Open ureteroplasty with buccal mucosa graft for long proximal strictures: A good option for a rare problem.

PurposeTo report a single surgeon experience with one year follow-up after open ureteroplasty with buccal mucosa graft (OUBMG) in the rare situation of long segment proximal ureteral strictures.Materials and MethodsFour patients with long segment proximal ureteral stricture underwent OU-BMG between February and July 2017. Functional outcome was assessed by pre- and postoperative serum creatinine, ultrasound and renal scintigraphy as well as patient reported outcomes.ResultsFour patients with an average stricture length of 4 cm underwent OU-BMG between February and July 2017. No major postoperative complications occurred. Retrograde uretero-pyelography 6 weeks postoperatively revealed a watertight anastomosis followed by immediate emptying of the renal pelvis and ureter in all four patients. Ureteroscopy at this time showed a wide lumen with well-vascularized pink mucosa. After a mean follow-up time of 12.5 (12–14) months, postoperative serum creatinine was unimpaired. Renal scintigraphy revealed no signs of renal obstruction. With regard to intraoral surgery, no difficulties with mouth opening or intraoral dryness or numbness were reported.ConclusionsFor patients with long segment ureteral strictures OU-BMG is a safe technique with excellent surgical and functional outcomes. Hence, the application of this technique should be encouraged and regarded as one of the standard options in case of this rare problem.

Non Transecting Dorsal Onlay and Ventral Inlay Buccal Mucosal Substitution Urethroplasty for Obliterative Bulbar Urethral Strictures

Background: Dorsal or ventral single layer repair can be impractical when there is an inadequate strip of urethra. Staged urethroplasty and non-transecting bilayer substitution urethroplasty are the other alternatives. Objectives: To assess the safety and outcome of non-transecting dorsal onlay and ventral inlay buccal mucosal substitution urethroplasty technique. Method: Between January 2014 and December 2018, 21 patients underwent non-transecting, double-layer, buccal mucosal urethroplasty for inflammatory bulbar urethral strictures. Four weeks after surgery, foley catheters were removed and voiding trial was given. Clinical examination and uroflowmetry (UFM) were done at 1, 3, and 6 months after surgery. Annual follow-up with flow rate and post-void residual assessment were also recorded. Failure was defined as a condition when there was flow rate deterioration (<15 mL/s) or when there is stricture recurrence (<20 Fr). Results: The mean age was 49.5 years. There was no significant difference in comorbidities among the patients. The mean duration of operative time was 259 min. The mean blood loss was 190 mL. The follow-up duration ranged from 12 to 66 months. The average length of stricture was 3.9 cm. The mean diameter of stricture segment was 1.96 mm. Comparison of UFM trend during follow-up was statistically significant (p = 0.05). One patient had Clavien-dindo grade 1, while 2 patients had grade 3b complications. Two patients had soft anastomotic site stricture and were treated successfully with endoscopic internal urethrotomy. The success rate was 90.47%. Conclusions: Non-transecting bilayer substitution urethroplasty is safe and has better short-term outcome in case of obliterative inflammatory urethral strictures.

Анастомотическая уретропластика без пересечения спонгиозного тела

The review analyzes the results of using non-transecting anastomotic urethroplasty in men with urethral strictures. Identified 14 original studies using this technique: 13 foreign and 1 Russian. In total, this technique was applied in 704 patients. This technique was used in 85% of cases with bulbar urethral stricture, in 15% - with posterior stricture.The average length of the urethral stricture in all studies was less than 2 cm, except for two works, where the average stricture length was 2.3 cm and 3.9 cm, respectively. This technique is equally successfully applied in all etiological variants of urethral stricture. The incidence of postoperative complications in all studies using non-transecting anastomotic urethroplastyaveraged 13.7%.Postoperative complications were mostly mild and corresponded to G1 according to Clavien-Dindo classification.According to 10 out of 14 studies that evaluated the effect of surgical treatment on the occurrence of erectile dysfunction (ED), the incidence of ED de novo was on average 13.4%. The success of treatment with the use of non-transecting anastomotic urethroplastyaveraged 95% (82-100%) with a median postoperative follow-up of 27 months (6-64 months). In 4 out of 14 studies, an additional comparison was transecting versus non-transecting techniques. Non-transecting technique was not inferior to transecting technique by any criterion, but, on the contrary, exceeded it in a number of indicators, including the dynamics of sexual function after surgery.On the basis of available studies on the use of non-transecting anastomotic urethroplasty, this technique should be recognized as a highly efficient and reasonably safe method for treating short urethral strictures and recommended for widespread clinical use.

Outcome Predictors of Augmentation Urethroplasty Using Dorsal Onlay Buccal Mucosal Graft

Background: The incidence and timing of stricture recurrence and factors affecting urethroplasty outcomes remains incompletely characterized. Objective: To evaluate and determine the factors predicting the outcome of dorsal onlay buccal mucosal graft (BMG) urethroplasty. Patients and Methods: We analyzed the records of 115 patients underwent dorsal onlay BMG urethroplasty at Al-Azhar University Hospitals in Cairo, Egypt, from January 2015 to April 2018, with a minimum of 12 months of followup. The risk factors examined were patient age, stricture etiology, site, length, width, diabetes, hypertension, smoking, obesity, previous visual internal urethrotomy (VIU) and urethroplasty, early postoperative complications, extravasation at first periurethral ascending cystourethrogram (ACUG) and stricture width. Results: Average patients age was 38 years. Stricture free rate was 90.4% and mean followup period was 47.5 months (range 12 to 67). Average stricture length was 5.9 cm, average stricture width was 6.3 mm, 63.4% of patients were with previous VIU, and 9.5% were with previous urethroplasty. On univariate analysis, etiology, site of stricture, previous four or more times VIU, DM, obesity, stricture length, postoperative (post op.). wound infection and leakage at first periurethral ACUG were associated with stricture recurrence. On multivariate analysis panurethral stricture (HR 280.6, 95% CI 9.1-8622.8, p =0.001), traumatic stricture (HR 17.1, 95% CI 2.4-123.4, p =0.005) were independent predictors of stricture recurrence. Stricture width, previous urethroplasty, the number of failed endoscopic procedures less than 4 times, smoking, HTN and patient age did not affect the recurrent stricture rate. Conclusion: panurethral and traumatic strictures were independent predictors of stricture recurrence.

Spectrum of management options for pediatric pelvic fracture urethral injury and outcome analysis: 12-year tertiary center experience

IntroductionPediatric pelvic fracture–associated urethral injuries (PFUIs) are relatively rare injuries that occur in secondary to high impact pelvic trauma. There is no consensus yet on the optimal management approach. ObjectivesIn this study, the authors reviewed their experience of pediatric PFUIs and discussed the current spectrum of potential management options. Study designThe authors retrospectively evaluated a cohort of 33 children (≤14 years) treated for PFUI between January 2005 and December 2017. ResultsThe mean age of presentation was 11.2 ± 2.1 years (range 6–14). All the subjects were male. Average stricture length was 2.5 + 1.4 cm. Transperineal anastomotic repair (TPAR) was done in 27 patients; Mitrofanoff procedure was done in three patients; Badenoch's procedure, preputial flap, and transpubic urethroplasty (TPU) was done in 1 patient each. Overall success rate for TPAR was 85%. Minor complications (Clavien grade I and II) were seen in eight cases (24.2%). Average hospital stay was 11.3 days (range 6–15). The mean follow-up duration was 13.8 months (range 9–18). DiscussionAs not many large overview studies were known, this retrospective study is small step for developing a protocol for patients with a pediatric PFUI that needs treatment. The goal of surgery in pediatric PFUI–associated posterior urethral strictures is to achieve a tension-free bulboprostatic anastomosis after excision of the distraction segment. Transperineal anastomotic repair is the best and most commonly performed surgery for pediatric PFUI with 85–98% success rates. The success rates for TPAR may be lower in children because of smaller pelvic cavity, small caliber urethra, and poorly formed elastic spongiosa. Hence, a TPAR should be attempted in every case of posterior urethral stricture post-PFUI. If a tension-free anastomosis is not possible, then procedures depending on local stricture characteristics such as TPU may be required. ConclusionMost pediatric posterior urethral strictures post-PFUI (≤2 cm) can be managed by delayed TPAR with reasonable success rates. Few selected patients may require procedures such as TPU based on local stricture characteristics.TableFactors affecting choice of surgery and outcomeTableSurgery groupNo.Previous interventionDefect siteMean defect length (cm)SuccessFailureTPAR274BMU-25BU-022234Badenoch procedure11BMU-01410Mitrofanoff30BMU extending upto BN-03630Preputial flap urethroplasty11BMU-01401TPU11BMU + Long BU segment-01510TPAR, transperineal anastomotic repair; TPU, transpubic urethroplasty; BMU, bulbomembranous; BU, bulbar urethra; BN, bladder neck.

Resection Urethroplasty for Urethral Stricture: Preliminary Findings from a Tertiary Care Hospital of Central Nepal

Background: Urethral stricture is relatively common problem that we encounter in urological practice. As urethral stricture causes progressive narrowing of the urethral lumen, signs and symptoms of urinary obstruction arise. These patients experience obstructive symptoms like poor stream, straining to urinate, incomplete voiding, end dribbling, urinary retention and recurrent urinary tract infections.&#x0D; Methods: A prospective cohort study was carried out in College of Medical Sciences, Chitwan, Nepal. All the patients who were operated with end to end anastomosis for urethral stricture with stricture length not more than 2.5cm from January 2015 to June 2016 was included in this study. These patients were followed up for two year period for recurrence of the stricture and complications.&#x0D; Results: Mean age of patient in this study was 50.55 years, average length of stricture was 1.3 cm. 66.67% (12 patients) had complete success with no recurrence of the stricture. 33.33 % (6 patients) had recurrence of stricture. Out of those 6 patients, 3 had undergone DVIU with no further recurrence of the stricture until the follow up period, one patient was treated with dilatation, two had complete failure and needed re-procedure.&#x0D; Conclusions: End to end anastomosis for short segment stricture had a fairly satisfactory result.