Bulbomembranous Urethroplasty Research Articles

465 - How and for how long should patients be followed up after bulbar or bulbomembranous urethroplasty?

465 - How and for how long should patients be followed up after bulbar or bulbomembranous urethroplasty?

V76 - Bulbo-membranous urethroplasty with “BAES-flap”: A description of the surgical technique

V76 - Bulbo-membranous urethroplasty with “BAES-flap”: A description of the surgical technique

Preliminary clinical study on non-transecting anastomotic bulbomembranous urethroplasty.

This study aims to investigate the effect of non-transecting anastomotic urethroplasty for treatment of posterior urethral stricture. A total of 23 patients with traumatic posterior urethral stricture were enrolled and then divided into two groups. In one group, 12 patients underwent non-transecting anastomotic urethroplasty. In the other group, 11 patients underwent conventional posterior urethra end-to-end anastomosis. The effect of operation was evaluated using the following parameters: the bleeding amount during operation, operation time, IIEF-5 scores after operation, maximum flow rate (Qmax), and rating scale of quality of life (QoL). The comparison between the conventional posterior urethra end-to-end anastomosis group and the non-transecting anastomotic urethroplasty group showed no significant difference with regard to average operation time. However, a significant difference was observed between the groups with regard to the bleeding amount during operation. The patients in the group of non-transecting anastomotic urethroplasty urinated smoothly after the removal of catheter. Meanwhile, one patient from the group of conventional posterior urethra end-to-end anastomosis had difficulty urinating after the removal of catheter. Furthermore, significant differences in the operation time, bleeding amount during operation, IIEF-5 scores after operation, and rating scale of QoL were observed, whereas no significant difference was observed between urine flow rates of the two groups after operation. Overall, nontransecting anastomotic urethroplasty is effective for posterior urethra reconstruction, and it can reduce the occurrence rate of erectile dysfunction after operation.

Decision Analysis Model Comparing Cost of Management Strategies for Pelvic Fracture Urethral Injuries

IntroductionWe compare the costs associated with primary endoscopic realignment vs delayed elective bulbomembranous anastomotic urethroplasty after initial management of pelvic fracture urethral injuries with suprapubic tubes. MethodsDecision analysis was performed comparing the costs associated with suprapubic tube placement with a definitive bulbomembranous urethroplasty performed 2 to 3 months after injury to those associated with primary endoscopic realignment. Model assumptions based on literature review included success rates of 30% for primary endoscopic realignment, 92% for bulbomembranous urethroplasty and 50% for direct vision internal urethrotomy. Using an institutional patient database of patients undergoing suprapubic tube placement, bulbomembranous urethroplasty and direct vision internal urethrotomy, costs were estimated based on hospital and operating room costs and Medicare reimbursement rates. Sensitivity analyses were performed by varying model assumptions. Using data from the Nationwide Inpatient Sample and the National Trauma Data Bank®, the annual incidence of pelvic fracture urethral injuries nationwide was estimated. ResultsThe total average cost of treating a pelvic fracture urethral injury with attempted primary endoscopic realignment is $11,043 vs $9,743 for suprapubic tube with elective bulbomembranous urethroplasty, for a savings of $1,300 (12%) per patient. For primary endoscopic realignment to be preferred, a success rate of 40% or better would be necessary. In addition, cost analysis calculation revealed that when bulbomembranous urethroplasty demonstrates an efficacy of 78% or greater, then suprapubic tube and elective bulbomembranous urethroplasty become more cost-effective than primary endoscopic realignment. ConclusionsGiven the added costs and variable outcomes of primary endoscopic realignment and subsequent endoscopic interventions, the durability of definitive urethroplasty appears to be cost-effective in treating men with pelvic fracture urethral injuries.

Re: Improving Outcomes of Bulbomembranous Urethroplasty for Radiation-Induced Urethral Strictures in Post-UroLume Era.

Objective To evaluate contemporary outcomes of excision and primary anastomosis (EPA) for the treatment of radiation-induced urethral strictures (RUS). Patients and Methods A retrospective review of 72 patients undergoing EPA for RUS from 2007 to 2015 by a single surgeon was performed. We analyzed overall and long-term success rates of EPA urethroplasty and compared patient cohorts from two groups, 2007-2012 vs 2013-2015 (post-Urolume). Results During the course of the study, we noted a near doubling of patient volume from the earlier (6.2 patients/year) to later (11.7 patients/year) cohorts. Among the 37 men treated from 2007 to 2012, we identified an EPA success rate of 70% compared with the improved 86% success rate in the subsequent cohort of 35 men treated from 2013 to 2015 ( P = .07). Single dilation was successful in 50% of initial and 40% of subsequent cohort patients in the treatment of recurrence. Initial and subsequent cohorts varied only in regard to stricture length (mean 2.0 cm vs 3.0 cm in initial and subsequent cohorts, P = .001) and number treated with Urolume stent (initial 5 vs none in the later cohort, P = .03). Length of follow-up (median 50 [17-97] months for the initial and 22 [6-34] months for the later cohort) was not associated with recurrence. Conclusion Increasing numbers of RUS patients are presenting for urethral reconstruction in the post-Urolume era. With increasing experience, we improved success rates of EPA urethroplasty to over 85% despite increased stricture length.

Improving Outcomes of Bulbomembranous Urethroplasty for Radiation-induced Urethral Strictures in Post-Urolume Era

To evaluate contemporary outcomes of excision and primary anastomosis (EPA) for the treatment of radiation-induced urethral strictures (RUS). A retrospective review of 72 patients undergoing EPA for RUS from 2007 to 2015 by a single surgeon was performed. We analyzed overall and long-term success rates of EPA urethroplasty and compared patient cohorts from two groups, 2007-2012 vs 2013-2015 (post-Urolume). During the course of the study, we noted a near doubling of patient volume from the earlier (6.2 patients/year) to later (11.7 patients/year) cohorts. Among the 37 men treated from 2007 to 2012, we identified an EPA success rate of 70% compared with the improved 86% success rate in the subsequent cohort of 35 men treated from 2013 to 2015 (P = .07). Single dilation was successful in 50% of initial and 40% of subsequent cohort patients in the treatment of recurrence. Initial and subsequent cohorts varied only in regard to stricture length (mean 2.0 cm vs 3.0 cm in initial and subsequent cohorts, P = .001) and number treated with Urolume stent (initial 5 vs none in the later cohort, P = .03). Length of follow-up (median 50 [17-97] months for the initial and 22 [6-34] months for the later cohort) was not associated with recurrence. Increasing numbers of RUS patients are presenting for urethral reconstruction in the post-Urolume era. With increasing experience, we improved success rates of EPA urethroplasty to over 85% despite increased stricture length.

Surgical Tips and Tricks During Urethroplasty for Bulbar Urethral Strictures Focusing on Accurate Localisation of the Stricture: Results from a Tertiary Centre

BackgroundThere are several techniques for characterising and localising an anterior urethral stricture, such as preoperative retrograde urethrography, ultrasonography, and endoscopy. However, these techniques have some limitations. The final determinant is intraoperative assessment, as this yields the most information and defines what surgical procedure is undertaken. ObjectiveWe present our intraoperative approach for localising and operating on a urethral stricture, with assessment of outcomes. Design, setting, and participantsA retrospective review of urethral strictures operated was carried out. All patients had a bulbar or bulbomembranous urethroplasty. All patients were referred to a tertiary centre and operated on by two urethral reconstructive surgeons. Surgical procedureIntraoperative identification of the stricture was performed by cystoscopy. The location of the stricture is demonstrated externally on the urethra by external transillumination of the urethra and comparison with the endoscopic picture. This is combined with accurate placement of a suture through the urethra, at the distal extremity of the stricture, verified precisely by endoscopy. Outcome measures and statistical analysisClinical data were collected in a dedicated database. Intraoperative details and postoperative follow-up data for each patient were recorded and analysed. A descriptive data analysis was performed. Results and limitationsA representative group of 35 male patients who had surgery for bulbar stricture was randomly selected from January 2010 to December 2013. Mean follow-up was 13.8 mo (range 2–43 mo). Mean age was 46.5 yr (range 17–70 yr). Three patients had undergone previous urethroplasty and 26 patients had previous urethrotomy or dilatation. All patients had preoperative retrograde urethrography and most (85.7%) had endoscopic assessment. The majority of patients (48.6%) had a stricture length of >2–7cm and 45.7% of patients required a buccal mucosa graft. There were no intraoperative complications. Postoperatively, two patients had a urinary tract infection. All patients were assessed postoperatively via flexible cystoscopy. Only one patient required subsequent optical urethrotomy for recurrence. ConclusionsOur intraoperative strategy for anterior urethral stricture assessment provides a clear stepwise approach, regardless of the type of urethroplasty eventually chosen (anastomotic disconnected or Heineke-Mikulicz) or augmentation (dorsal, ventral, or augmented roof strip). It is useful in all cases by allowing precise localisation of the incision in the urethra, whether the stricture is simple or complex. Patient summaryWe studied the treatment of bulbar urethral strictures with different types of urethroplasty, using a specific technique to identify and characterise the length of the stricture. This technique is effective, precise, and applicable to all patients undergoing urethroplasty for bulbar urethral stricture.