Bulbar Urethral Strictures Research Articles

Direct vision internal urethrotomy in the management of bulbar urethral strictures: long term follow up and factors predicting treatment failure.

Evaluation of long term results, risk factors for treatment failure and complications in a contemporary cohort of patients with bulbar urethral strictures managed with direct vision internal urethrotomy (DVUI). We retrospectively reviewed 140 consecutive patients who underwent internal urethrotomy in a single institution between January 2012 and October 2020, with a minimum follow up of 24 months. Most urethral strictures had a iatrogenic origin (89.3%), length under 2 cm (75%) and were located at the mid-bulbar urethra (56.4%). Main variable was treatment failure, defined as recurrent urethral stricture at the same location in urethrography or urethroscopy, or the need of dilation, internal urethrotomy or open urethral reconstruction. Secondary variables analysed were length of stricture, suspected etiology, previous endoscopic procedures, hospital stay, days of catheterization and postoperative complications such as infections or haematuria. Treatment failure occurred in 61.4% patients (104). Idiopathic strictures and those under 2 cm had better outcomes. Strictures longer than 2 cm and those with previous endoscopic procedures demonstrated a higher failure rate. More than 90% of recurrences occurred within the first two years of follow up. Complications of DVIU were scarce with postoperative urinary tract infection/urosepsis in 5.7% and prolonged haematuria in 10%. Mean hospital stay was 2.9 days. DVIU is a safe and simple technique, with reasonable efficacy in primary cases of bulbar urethral strictures under 2 cm length. Strictures longer than 2 cm or recurrent cases might be better approached through drug-coated balloon dilation or open urethral reconstruction. Follow up after DVIU must be at least 24 months.

Injection of platelet-rich plasma combined with dexamethasone with visual internal urethrotomy in treating short bulbar urethral stricture.

To evaluate long-term urethral patency of short bulbar urethral stricture management using visual internal urethrotomy with platelet-rich plasma (PRP) in conjunction with dexamethasone injection. This retrospective study included 78 male patients with symptomatic short bulbar urethral stricture (diagnosed by ascending urethrography) who were treated by internal urethrotomy after injection of submucosal PRP combined with dexamethasone. Every patient was monitored for urethral stricture recurrence one month after catheter removal and twenty-four months after internal urethrotomy. The etiology of urethral stricture was iatrogenic in 63 (80.8%) patients, inflammatory in 9 (11.5%) patients, and idiopathic in 6 (7.7%) patients. In terms of complications, two patients (2.7%) experienced bleeding per urethra, four patients (5.4%) had fever, three patients (4%) had hematuria, one patient (1.4%) had perineal abscess, and seven patients (9.5%) had a recurrence of stricture. The etiology of the stricture did not have any significance in patients who experienced recurrence (P = 0.77). Our findings suggest a potential protective effect of PRP and dexamethasone injection at the time of internal urethrotomy also decreased the length of stricture in case of recurrence. This protective effect lasted for at least 2years.

Ventral versus dorsal onlay buccal mucosal graft urethroplasty for non-traumatic proximal bulbar urethral strictures in sexually active men: erectile and urinary functions

PurposeTo compare the erectile and urinary functions of ventral and dorsal onlay buccal mucosal graft (BMG) urethroplasty in the management of proximal bulbar urethral strictures (PBUS) in sexually active men.Patients and methodsWe retrospectively included patients with primary non-traumatic PBUS who were treated with (BMG) urethroplasty at our department between March 2019 and March 2023 either ventral or dorsal approaches. Patients were assessed at 3- and 12-months postoperatively for urinary and erectile functions.Results133 patients were identified and underwent either ventral repair (n = 60, group I) or dorsal repair (n = 73, group II). There was no significant difference in baseline urinary and sexual function between both groups (p > 0.05). Overall, the success rate was 91.7% in Group I and 90.4% in Group II (p = 0.801). Transient ED (at 3 months) was detected in 5% and 25% (p = 0.002), while permeant ED (at 12 months) was 1.7% and 13.7% (p = 0.012) in group I and group II, respectively. Group I had significantly higher mean IIEF scores; 28.2 and 28.4 at 3 months (p < 0.001) and 12 months (p < 0.001); compared to Group II; 22.1 and 24.4, respectively.ConclusionThe ventral approach had better erectile functional outcomes compared to the dorsal approach in the management of non-traumatic PBUS in sexually active men. This might be related to less urethral mobilization and no dissection of the intercrural space during ventral onlay graft urethroplasty.

Assessment of predictive factors in endoscopic internal urethrotomy for bulbar urethral strictures

Assessment of predictive factors in endoscopic internal urethrotomy for bulbar urethral strictures

A Comprehensive Comparative Study of Direct Vision Internal Urethrotomy and Urethroplasty in Short-Segment Bulbar Urethral Strictures.

Background Currently, there is no data on the prevalence of urethral stricture illness in India.For short-segment bulbar urethral stricture, end-to-end anastomosis is the gold standard of care. The purpose of this study was to find where the direct vision internal urethrotomy (DVIU)exists in today's era. Also, it compared DVIUs with urethroplasty. Further, the comparison was performed in the urethroplasty group which was converted into two sub-groups; buccal mucosal graft (BMG) and anastomotic urethroplasty. Materials and methods It was a randomized prospective interventional study. The study was conducted at the Department of Urology at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna,India. The total duration of the study was one year and six months. Ethical approval for the conduction of the study has been obtained from the institutional ethics committee (IEC) of IGIMS, Patna, Bihar, India under letter number 840/IEC/IGIMS/2022 dated 10 December 2022. Results The study included two comparisons, one between urethrotomy and urethroplasty, that found significant differences in the International Prostate Symptom Score (IPSS) scores at three months. However, the IPSS scores were found to be insignificant between the groups at six months. Also, no statistically significant difference was observed in the International Prostate Symptom Score-Quality-of-Life (IPSS-QOL) between the two groups at three and six months. The statistically significant difference between them was observed in the maximum urinary flow rate (Qmax) and the International Index of Erectile Function-5 (IIEF-5)scores at three and six months, respectively. Another comparison was done between BMG and the excision and primary anastomosis (EPA) groups, where there was no statistical difference observed between the groups in terms of IPSS, IPSS-QOL, Qmax, and recurrence at three and six months. However, there was a statistical difference observed in IIEF-5 scores between the groups at three and six months, respectively. The mode of anaesthesia in the DVIU group was either total intravenous anaesthesia (TIVA) or spinal anaesthesia. On the other hand, all cases of BMG urethroplasty required general anaesthesia with nasal intubation and all cases of EPA required spinal anaesthesia. Conclusion It has been concluded that in today's era, DVIU can be considered for de-novoshort-segment bulbar urethral stricture in individuals who are concerned about sexual life. And, for short-segment bulbar urethral stricture less than 2 cm, BMG is a better alternative to EPA as it is associated with less erectile dysfunction. A decrease in erectile function is more common in anastomotic urethroplasty as compared to BMG urethroplasty.Further studies comparing muscle sparing, nerve sparing, and vessel sparing are required to address this problem.

Management of Catheter-Related Urethral Injuries in Male Children.

Management of urethral trauma lacks clarity in the paediatric population.There is no clear guidance for management and follow-up of these patientswhich can lead to missing the long-term sequelae of the primary injury. Catheter-associated urethral injuriesare less likely to cause a complete transaction of the urethra. This is due to the mechanism, typically caused by creating a false passage or inflating the balloon in the urethra.In partial urethral injuries, the European Association of Urology (EAU) guidelines suggest follow-up after one-two weeks of bladder drainage or a urethrogram. The purpose of this study was to reviewliterature related to the management and follow-up of catheter-induced urethral injuries,subsequently comparing this toa case seriesin a single paediatric tertiary centre. The aim was to propose a unique algorithm to safely and effectively guide clinicians for thispresentation. In our case series, 11 of 12 required initial bladder drainage.The data demonstrated an inconsistent approach to investigations throughout their admissions. Most cases had a successful trial without catheter (TWOC) or ability to resume continuous intermittent catheterisation. One patient needed a vesicostomy.We had a single bulbar urethral stricture, which wouldn't permit an 8fr catheter. This was managed using cystoscopy and serial urethral dilations. Our cohort islikely an underrepresentation of the actual number of catheter-related injuries in our institute. Some injuries are managed by the parent team without referring to paediatric urologists if spontaneous micturition occurs or if they manage to catheterise after an initial traumatic attempt. Conclusion: Catheter-related urethral injuries arecommonbut underreported. They are less likely to have long-term sequelae than other mechanisms of trauma. The majority of casesdo well following a period of initial bladder drainage. Current practise varies even in one institute as there are no clear management and follow-up guidance in current literature. Our proposed algorithmis a useful tooland decreases the incidence of missing long-term sequelae. Management algorithm: Post urethral injury, a child who is passing urine with conservative management is likely to have good long-term function. They would require re-assessment after discharge. In clinic they would require urinary flow assessment and post-void residuals. If not toilet trained, parental impression of whether their child's stream is interrupted or if they strain during urination would be assessed. Back-pressure changes would be considered on ultrasound scan (USS). If the assessment indicates concern, then a micturating cystourethrogram (MCUG) assessment for children younger than one or a cystoscopic assessment for children older than one would be recommended. Post urethral injury, if a child is unable to pass urine conservatively, then an urgent urological assessment would be appropriate. An attempt at catheterisation would be made. If unsuccessful, the patient would be assessed for theatre. If unfit for it, an ultrasound-guided suprapubic (SP) catheter would be advised. If the patient is fit, then a cystoscopic and wire-guided catheter would be preferred. Later, if they passed a TWOC, they would be managed as per the algorithm described above. If they failed the TWOC, MCUG would be proceeded to. Catheter management and regular follow-up, or for a definitive intervention would be planned for.

The outcome of nontransecting anastomotic urethroplasty in recurrent bulbar urethral stricture and its impact on sexual functions: A prospective observational study

Purpose: The management of recurrent bulbar urethral stricture had no consensus and faced many challenges such as the risk of failure, ischemia, and sexual dysfunction. Therefore, this study aimed to assess the outcome of nontransecting anastomotic urethroplasty in recurrent bulbar urethral stricture disease (USD) less than 3 cm and its impact on sexual functions. Material and methods: This is a prospective descriptive study that included patients with recurrent bulbar USD ≤ 3 cm. Full history taking and clinical examination, including International Prostate Symptoms Score (IPSS) and International Index of Erectile Function (IIEF-5), were documented. Moreover, retrograde urethrogram, uroflowmetry, and penile Doppler were undergone. The nontransecting urethroplasty techniques were performed: Heineke-Mikulicz principle stricturoplasty for stricture ≤1 cm without excision of the stricture and nontransecting excision and primary anastomosis without transecting the corpus spongiosum for stricture 1 to 3 cm. Each patient was routinely evaluated through a 12-month follow-up using IPSS and IIEF, uroflowmetry, and postvoiding residual urine. Results: Thirty-three patients were included in the study with a mean stricture length of 1.45 ± 0.7 cm. Twelve patients had failed previous urethroplasty, while 21 patients had previous visual internal urethrotomy. Nontransecting excision and primary anastomosis in 14 patients and Heineke-Mikulicz principle stricturoplasty in 19 patients were performed. There was no recurrence of stricture urethra, except for one patient, who required visual internal urethrotomy at a 3-month follow-up, with mean postoperative IPSS of 3.04 ± 2.745, Qmax 23.89 ± 2.714 mL/s, and postvoiding residual urine 26 ± 33 cc. No significant differences were reported between pre- and postoperative IIEF (18.61 ± 5.448 versus 19.33 ± 5.599, respectively, P = 0.236). Conclusion: Nontransecting urethroplasty can achieve a high success rate in short recurrent bulbar USD without the potential sexual morbidity.

Evaluación de los factores predictivos tras uretrotomía interna endoscópica para estenosis de uretra bulbar

Evaluación de los factores predictivos tras uretrotomía interna endoscópica para estenosis de uretra bulbar

Decision regret and long-term success rates after ventral buccal mucosa graft urethroplasty.

To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics. Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses. A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group. This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.

Intralesional injection of mitomycin C following visual internal urethrotomy for recurrent urethral stricture: a randomized controlled study.

To assess the efficacy of Intralesional injection of mitomycin C (MMC) following visual internal urethrotomy (VIU) in the management of recurrent urethral stricture. Fifty male patients diagnosed with recurrent single bulbar urethral stricture measuring less than 1.5 cm previously treated with VIU were randomly allocated into two equal groups, (Group A) planned for VIU only and (Group B) planned for VIU with intralesional MMC injection using Botox injection needle. All patients were objectively evaluated pre- and post-operatively at 3, 6, and 12 months using uroflowmetry, post-void residual urine volume, and retrograde urethrography. Forty-five patients completed their follow-up in our study. Patients who underwent intralesional MMC injection showed significant improvement in uroflowmetry, post-voiding residual, and with a success rate (82.6% in Group B, compared to 50% in Group A with a highly statistically significant difference, p-value: <0.001). VIU with MMC was the only factor associated with a marked decrease in stricture recurrence (p = 0.02) as shown in the Multivariate Cox regression analysis. Intralesional injection of mitomycin C seems to be a safe and effective modality in reducing the recurrent stricture rate after VIU.

Does the suturing technique (barbed continuous versus conventional interrupted) impact the outcome of anastomotic urethroplasty?

To evaluate and compare continuous suture (CS) and interrupted suture (IS) techniques applied in excision and primary anastomosis (EPA) urethroplasty in terms of surgical success and complication rates. A retrospective evaluation was conducted on patients with bulbar urethral strictures measuring ≤ 2.5cm who underwent EPA between April 2020 and December 2022. Patients with a history of urethral reconstruction, multiple strictures, a history of pelvic radiotherapy, a diagnosis of Lichen sclerosis, a history of surgery due to congenital penile curvature or Peyronie's disease, and a follow-up period of less than 12months were excluded. The patients were divided into two groups according to the suture technique used (CS or IS), and the groups were compared for demographic and perioperative data. A total of 97 patients (CS n = 52, IS n = 55) were included in the sample. The mean age of the entire patient group was calculated to be 56.2years and the mean stricture length was 19.3mm. Operation time and postoperative catheter time were shorter in the CS group (94.7 ± 7.3 vs. 117.2 ± 5.7min and 9.9 ± 1.6 vs. 15.8 ± 1.9min, p < 0.001, respectively). The groups were similar regarding anatomical success, stress urinary incontinence, penile numbness, curvature, and postoperative infection (p > 0.05). No significant difference was observed in terms of success or complications between the CS and IS techniques employed during EPA urethroplasty. However, in addition to reducing the operation time, the CS technique offers the advantage of safely removing the urethral catheter earlier.

Optimised Protocol for Managing Failed Catheterisation: Leveraging Bedside Retrograde Urethrography and Cystourethroscopy.

Introduction Urethral catheterization is a routine procedure often required for many hospitalized patients. Various conditions, such as meatal stenosis, stricture urethra, false passage, benign prostatic hyperplasia, bladder neck contractures, and impacted urethral stones, can contribute to difficulty in catheterisation. In the setting of failed attempts at per urethral catheter placement, the subsequent intervention is suprapubic catheter (SPC) insertion. SPC placement has its associated complications and causes inconvenience to the patients. We framed an algorithm to minimise the need for SPC insertion in cases of difficult per urethral catheterisation in a non-trauma setting. This study aimed to evaluate the common causes of difficult per urethral catheterisation and establish the efficacy of our algorithm in managing difficult catheterisation with bedside retrograde urethrography (RGU) and cystoscopy while avoiding SPC placement. Materials and methods This prospective observational study was conducted from September 2022 to June 2024. Patients admitted with urinary retention or requiring routine catheterisation, with one failed attempt at catheterisation, were included in the study. Our algorithm for the management of difficult catheterisation in a non-trauma setting, to avoid SPC, integrates a bedside RGUand retrograde urethroscopy using either a 15.5 Fr cystoscope sheath or a 6 Fr ureteroscope to identify the urethral pathology, followed by dilatation and per urethral catheterisation. Results Among 55 patients (aged 34-82 years), 48 (87.27%) were male and seven (12.73%) were female. The most common indication for catheterisation was routine catheterisation for output monitoring (n = 30; 54.54%), followed by acute retention (n = 25; 45.45%). Bulbar urethral stricture (n = 28; 50.9%) was the most common cause of difficult catheterisation, followed by meatal/sub-meatal narrowing (n = 13; 23.63%), enlarged prostate or high bladder neck (n = 4; 7.27%), and impacted stones (n = 3; 5.45%). Successful catheterisation was achieved in 48 male patients following urethroscopy with a 6 Fr ureteroscope or 15.5 Fr cystoscope. In females, reducing the pelvic organ prolapse enabled catheterisation in two cases, while five required serial dilatation and catheterisation. Successful per-urethral catheterisation was achieved in all 55 (100%) patients, thus avoiding SPC. Conclusions Conventional blind catheterisation techniques have limited success in the setting of failed initial catheterisation. This approach, which employs bedside fluoroscopy and direct visualisation of the urethra using a cystoscope or ureteroscope, helped achieve higher success rates (n = 55; 100%) for difficult per-urethral catheterisation and avoided the need for SPC. Proper implementation of this protocol for dealing with difficult per-urethral catheterisation will reduce the unnecessary burden on the healthcare system by minimising the potential iatrogenic urethral injuries and reducing the need for SPC.

Ventral-approach augmented nontransected anastomotic (vANTA) urethroplasty for bulbar urethral strictures: a single-center experience.

This study describes ventral-approach augmented nontransected anastomotic (vANTA) urethroplasty and presents the preliminary functional results of patients treated with this technique. Twenty-three patients who underwent vANTA urethroplasty were included in the study. Stricture location, stricture length, preoperative uroflowmetry parameters (maximum flow rate (Qmax) and mean flow rate (Qmean)), preoperative International Index of Erectile Function (IIEF)-5 scores, operation time, postoperative complications, length of hospital stay, and follow-up periods were recorded. The Qmax, Qmean, and IIEF-5 scores of the patients were recorded again in the second and twelfth postoperative months. Preoperative and postoperative Qmax values and IIEF-5 scores were compared. Kaplan-Meier survival analysis was performed to demonstrate recurrence-free survival. The mean age of the patients included in the study was 52.1 ± 16.9 years. Mean stricture length was 2.5 ± 0.5 cm. There was a statistically significant difference between preoperative and 2-month postoperative uroflowmetry Qmax values (6.9 (0.0-14.5) vs. 18.5 (5.5-41.5) mL/s; p < 0.001). There was no statistically significant difference in preoperative and 2-month postoperative IIEF-5 scores (p > 0.05). There was a statistically significant difference between preoperative and 1-year postoperative median Qmax values (7.2 (0.0-12.3) vs. 17.4 (11.2-24.3) mL/s; p = 0.001). There was no statistically significant difference between preoperative and 1-year postoperative IIEF-5 scores (p > 0.05). According to Kaplan-Meier recurrence-free survival analysis, the recurrence-free survival rate at 6 months was 95.7. In cases of bulbar urethral strictures, vANTA urethroplasty is an effective treatment option with limited postoperative complications. Preserving the underlying corpus spongiosum is important to avoid impaired sexual function.

The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis.

The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis.

Bulbar urethroplasty techniques and stricture recurrence: differences between end-to-end urethroplasty versus the use of graft.

Urethral stricture (US) affects most commonly the anterior portion of the urethra, concretely the bulbar, with a significant incidence in men. Open urethroplasty is the gold standard treatment. However, stricture recurrence (SR) remains a current subject of concern. The aim of the present review is to provide an updated literature summary on surgical urethroplasty techniques for bulbar US and prognostic factors for SR, comparing the different approaches. For short strictures, excision and primary anastomosis (EPA) is the preferred option, with success rates exceeding 90%. Substitution techniques are usually required for longer strictures (>2-3cm). Buccal mucosa graft (BMG) remains the first choice as it complies with ideal features, with no significant differences regarding the site of graft implantation. Stricture length, time since urethroplasty and number of previous urethral interventions are risk factors for failure. Also, surgeon's experience affects technique selection and future outcomes. There seems to be consensus on a higher SR rate following substitution techniques compared to EPA, which appears to be influenced by the stricture length, usually longer in the former group. Furthermore, there is a trend in favor of endoscopic management of SR, except for long and complex recurrences where grafts should be used. In conclusion, multiple urethroplasty techniques are available and selection must be carefully individualized, focusing on stricture characteristics, patient's history, and surgeon's experience. Well-designed studies with clear definitions and follow-up protocols are still necessary to develop standardized guidelines on the management of bulbar US.

Extracorporeal robotic-assisted anastomotic urethroplasty in a case of complex traumatic bulbar urethral stricture

ABSTRACT Robotic-assisted surgery is usually done intracorporeally by placing the robotic arms through the preplaced ports. There have been publications of microsurgery done with the assistance of robotic systems by extracorporeal route. We are presenting here a case of extracorporeal robotic assisted anastomotic urethroplasty in a case of complex traumatic bulbar urethral stricture by air docking of the robotic arms of the Davinci XI system. To our knowledge, this is the first case of urethral stricture done by this technique.

Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy?

Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy?

High frequency of concomitant squamous metaplasia in bulbar urethral stricture and its association with reconstructive delay and urethral rest.

To determine the prevalence of concomitant squamous metaplasia (SM), the initial histological change from normal urethra to urethral stricture, in bulbar urethral strictures and to investigate the associated clinical factors. A retrospective review was conducted on 165 male patients with bulbar urethral strictures who underwent excision and primary anastomosis (EPA) between 2010 and 2020, for whom complete clinical data and excised urethral specimens were available. An experienced pathologist histologically evaluated concomitant SM in paraffin sections of the proximal end of the excised urethra blinded to the clinical data. Disease duration was calculated as the period from the initial diagnosis of urethral stricture to the date of EPA. The association between concomitant SM and clinical background was investigated. SM was identified in 86 (52.1%) patients. The median disease duration in patients with SM (38months) was significantly longer than that in patients without SM (9months, p < 0.0001). In multivariate analysis, the longer disease duration, non-traumatic stricture etiology, and failure to maintain urethral rest with urinary diversion via a suprapubic tube for more than 90days were independent factors predicting concomitant SM. No significant difference was observed in success rates of EPA between patients with SM (93.2%) and those without SM (97.5%, p = 0.18). Reconstructive urologists need to be aware that concomitant SM is frequent in patients with bulbar urethral stricture, especially in those with long disease duration and those who were voiding volitionally during the period of urethral rest.

Clinical observation of male bulbar urethral strictures resulting from straddle injuries associated with falling from heights and riding activities

ObjectivesTo retrospectively investigate and analyze the characteristics of male bulbar urethral strictures or occlusions resulting from straddle injuries caused by falling from heights and riding activities.MethodsThe study included 56 patients with a history of straddle injury, who were divided into two groups: the falling group (n = 29) and the riding group (n = 27). All patients underwent urethroscopy and X-ray urethrography, followed by urethrotomy and anastomotic procedure. Both urethral and suprapubic catheters were retained for one month postoperatively. Subsequent follow-up assessments were conducted within one month to one year after surgery.ResultsThe clinical data of two groups were analyzed. The average ages were 40.1 ± 11.2 (falling group, aged 18–59) and 26.8 ± 4.4 (riding group, aged 19–35), P < 0.05. In the falling group, 21 cases (72.4%) had offspring, while in the riding group, only 3 cases (11.1%) had offspring, P < 0.05. The stricture segments in the falling group were predominantly located in the proximal part of the bulbar region (89.7%), whereas in the riding group they mainly found in the distal part (96.3%), P < 0.05. In terms of urethrography results, the average lengths of stricture segments were measured as 17.6 ± 2.8 mm and 15.5 ± 4.6 mm respectively, P < 0.05. During surgery, the average lengths of stricture segments were recorded as 19.0 ± 2.5 mm and 17.4 ± 6.1 mm, P > 0.05. In the falling group, 20 cases (69.0%) involved bulbocavernosus muscle injury, P < 0.05. In the riding group, 5 cases (18.5%) involved corpus cavernosum injury, P < 0.05. After one month of the operation, all cases were able to pass through the 16Fr urethroscope without any apparent urethral strictures or complications observed in urethrography results. The maximum urinary flow rate for all cases exceeded 15 ml/s. Two months and one year after the operation, all cases experienced smooth urinary flow and ejaculation without any disorders reported. 3 cases (10.3%) in the falling group and 7 cases (25.9%) in the riding group complained of urethral stretching pain during erection, P > 0.05.ConclusionsMale bulbar urethral strictures or occlusions resulting from straddle injuries associated with falling from heights and riding activities exhibit distinct characteristics, necessitating the development of a comprehensive surgical plan tailored to the specific features of each condition and the diverse age groups affected.

Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report

Background: Urethral strictures and benign prostatic hyperplasia (BPH) are 2 common causes of urinary obstruction and urinary emptying symptoms. While urethroplasty and endoscopic management of BPH have been extensively discussed in the literature when performed on their own, a case of simultaneous urethroplasty and endoscopic management of BPH has not been previously described in the literature. Case Description: We present the case of a 75-year-old man with significant BPH and concomitant bulbar obliterative urethral stricture. After discussion of treatment options with the patient, we elected to perform both holmium LASER enucleation of the prostate (HoLEP) of a 200cc prostate and buccal graft urethroplasty during the same surgery. The HoLEP was performed through a dorsal urethrotomy in anticipation of urethroplasty. Nontransecting anastomotic repair was then combined with the buccal graft urethroplasty. The patient did not have any acute postoperative complications and had no recurrence. He reported improvements in outcome questionnaire scores and uroflow parameters at the 12-month follow-up. Conclusions: This case presentation is the first to report on simultaneous complex urethroplasty and endoscopic management of BPH, specifically HoLEP. It shows that this approach can lead to positive urinary outcomes without added complications and with lasting outcomes, thereby allowing the use of a combined surgical approach.