Stricture Etiology Research Articles

Etiology and Evaluation of Female Urethral Strictures

Etiology and Evaluation of Female Urethral Strictures

Pyloroduodenojejunostomy

Background: Gastric outlet obstruction is a common condition due to various malignant and benign etiologies. Benign gastric outlet obstruction has been managed surgically by gastric resection or drainage procedures. Pyloroduodenojejunostomy (PDJ) is an old surgical procedure with very few descriptions in the literature and is rarely performed now. We present our experience of six cases of Roux-en-Y PDJ performed for benign gastroduodenal strictures causing gastric outlet obstruction.Materials and Methods: Prospective study of patients who underwent Roux-en-Y PDJ for benign gastroduodenal obstruction in the department of Surgical Gastroenterology in a teaching hospital in Northern India from January 2017 to December 2019. Side-to-side pyloroduodenojejunostomy was done with a Roux-en-Y limb of jejunum along with side-to-side jejunojejunostomy. A feeding jejunostomy was added in patients who were nutritionally poor. No vagotomy was performed.Results: Four male and two female patients with median (range) age of 42 (37–61) years underwent PDJ. There were no major postoperative complications in the study group. Etiology of benign strictures was tuberculosis in two patients and peptic in four. On mean (standard deviation [SD]) follow-up of 19.5 (5.12) months, all the patients were symptom-free. The mean (SD) weight gain was 10 (3.40) kg.Conclusion: Roux-en-Y PDJ is a useful alternative in the management of surgically difficult cases of benign gastroduodenal strictures with low morbidity and good outcome.

Percutaneous transhepatic management of biliary strictures in patients with dysfunctioning plastic biliary endoprostheses.

To evaluate the safety and outcomes of percutaneous transhepatic management of dysfunctioning plastic biliary endoprostheses (PBE) in patients with benign/malign biliary strictures. Twenty-nine patients (22 men, 7 women; mean age of 60.7 (range 33-88) years) diagnosed with dysfunctioning PBE were included. Percutaneous transhepatic biliary drainage and subsequent PBE dislodgment into the bowel were performed in all cases. Patient demographics, etiology of the biliary stricture, indication, technical success, complications, and clinical outcomes were gleaned from medical records. Seventeen patients had malignant strictures, while 12 patients had benign conditions. A total of 36 PBE (33 straight, 3 double-J) were treated. Six patients had more than one PBE. Successful dislodgement of the PBE was achieved in 28 (96.6%) of the cases. Monorail threading was performed in 8 cases while dislodgement by balloon friction was utilized in 21 patients. There was no statistical significance between benign and malignant biliary strictures regarding dislodgement duration (p = 0.080). No major complication was encountered. Thirteen minor complications in 10 patients including abdominal pain (n = 8) and mild hemobilia (n = 5) were observed and treated conservatively. Uneventful passage of the PBE was reported by all patients with technical success. Percutaneous transhepatic methods aid as a reasonable alternative in the treatment of benign and malignant biliary strictures in patients with dysfunctioning PBE when endoscopic approaches fail or are not eligible.

Testosterone, Urethral Vascularity, and Urethral Stricture Disease: A Review

Urethral stricture disease is one of the oldest described urologic pathologies and urethroplasty is associated with high success rates. Many urethral strictures are thought to arise from iatrogenic injury or radiation therapy which can create ischemic insults to the urethra. In developed countries, most urethral strictures are idiopathic; therefore, much is still unknown about the etiology and pathogenesis of this disease. Testosterone is known to mediate vasculogenesis through vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1α (HIF-1α) pathways in various organs. Recently, testosterone has been shown to mediate urethral vasculogenesis. In the setting of testosterone deficiency, androgen supplementation can improve urethral vascularity. Further, there appears to be a high incidence of testosterone deficiency in men with urethral strictures. Despite many advances in our understanding of testosterone’s association with the urethra over the past few years, there remains much to be learned about the mechanism of testosterone on urethral stricture etiology and whether testosterone deficiency and supplementation impact urethral reconstruction outcomes.

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China.

Background: Male urethral stricture is a disease with a high incidence rate. With social-economic development in the developing countries, the trend of etiology and treatment of male urethral stricture changed was speculated.Methods: The clinical data of the male patients with urethral stricture from 2000 to 2019 were analyzed. The subjects were divided into Group A (2000–2009) and Group B (2010–2019) according to treatment time. The pooled analysis of the data extracted from pieces of literature was also performed.Results: About 540 patients were included in the present study, including 235 patients in Group A and 305 patients in Group B. In recent 10 years, trauma has still been the main cause of urethral stricture. Iatrogenic injury, especially transurethral operation, increases significantly, while male urethral stricture secondary to radiotherapy and infection decrease. Urethroplasty increases and the reoperation rate decreases in treating simple urethral stricture, and flap urethroplasty also increases in treating complex urethral stricture. The results of a pooled analysis of data from 11 centers in Mainland China are partially consistent with it. Complications, such as urethral fistula, false canal, ejaculation disorder, and penile curvature, decrease significantly.Conclusions: The main causes of urethral stricture in the recent 10 years are still trauma and iatrogenic injuries, and the etiology of urethral stricture is related to socioeconomic development. With the increase of intracavitary minimally invasive treatment and flap urethroplasty, the curative effect is increasing, while iatrogenic urethral stricture cannot be ignored.

P077 Incidence of Colonic Strictures - A Systematic Review and Meta-analysis.

Intestinal strictures are a complication of the inflammatory bowel diseases (IBD, including ulcerative colitis (UC) and Crohn's disease (CD)) that can lead to bowel obstruction and therapy failure. Intestinal strictures occurring after long-standing tissue damage and repair are more frequently reported in CD, but colonic strictures can occur in UC. However, there is a paucity of literature that comprehensively summarizes the available information regarding the incidence and etiology of colonic strictures in UC. The aim of this study was to perform a systematic review and meta-analysis of published reports on the incidence of colonic strictures in UC patients. Four independent reviewers performed a comprehensive review of all original articles describing the incidence of colonic strictures in UC published from inception to June 2021. Primary outcomes were (1) overall incidence of colonic strictures; (2) 10-year incidence of colonic strictures; and (3) incidence of colonic strictures containing high-grade dysplasia (HGD) or colorectal cancer (CRC). Subgroup analysis was performed to compare the outcomes between the pre-biologic era and post-biologic era. The meta-analysis was performed and the statistics were 2-tailed. Finally, probability of publication bias was assessed using funnel plots and with Egger's test. Eleven studies reporting on a total of --- patients with colonic strictures were included in the analysis after comprehensive search. This yielded a pooled colonic stricture incidence rate of 5.4% (95% confidence interval (CI) 3.7-7.8). The incidence rate of colonic strictures was lower in the post-biologic era compared to the pre-biologic era but the difference was not statistically significant (2.6% vs 6%; p = 0.14). The pooled 10-year colonic stricture rate was 3.2% (95% CI 1.5-6.8). The pooled 10-year incidence rate of colonic strictures was lower in the post-biologic era compared to the pre-biologic era but the difference was not statistically significant (1% vs 1.8%; p = 0.1). The pooled incidence of strictures with associated high-grade dysplasia (HGD) or colorectal cancer (CRC) was 21.9% (95% CI 12.2-36.5). The incidence rate of HGD or CRC in colonic strictures was higher in the post-biologic era compared to the pre-biologic era but the difference was not statistically significant (23.6% vs 20.4%; p = 0.79). This systematic review and meta-analysis on the incidence of colonic strictures in UC showed that the overall pooled incidence and 10-year incidence of colonic strictures in UC are low. There was a trend towards lower incidences of UC strictures in the post-biologic era, although the differences did not reach statistical significance. While the overall incidence of colonic strictures, in UC is low, a high proportion of colonic strictures are associated with HGD or CRC, even in the biologic era. Therefore, this study provides further support for importance of stricture biopsy and surgical evaluation for colectomy in the UC patient with colonic stricture.

Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience.

Benign ureteroenteric anastomosis strictures (UESs) are one of many critical complications that may cause irreversible disability following robot-assisted radical cystectomy (RARC). Previous studies have shown that the incidence rates of UES after RARC can reach 25.3%, with RARC having higher UES incidence rates compared to open radical cystectomy. Various known and unknown factors are involved in the occurrence of UES. To minimize the incidence of UES after RARC, our group has standardized the procedure and technique for intracorporeal urinary diversion by applying the following five strategies: (1) wide delicate dissection of the ureter and preservation of the periureteral tissues; (2) gentle handling of the ureter and security of periureteral tissues at the anastomotic site; (3) use of indocyanine green to confirm good blood supply; (4) standardization of the ample ureteral spatulation length for Wallace ureteroenteric anastomosis through objective measurements; and (5) development of an institutional standardized procedure manual. This review focused on the incidence, etiology, prevention, and management of UES after RARC to bring attention to the incidence of this complication while also proposing standardized surgical procedures to minimize its incidence after RARC.

MONOPOLAR VS BIPOLAR TRANSURETHRAL RESECTION OF PROSTATE REGARDING THE INCIDENCE OF POSTOPERATIVE URETHRAL STRICTURE: A PROSPECTIVE RANDOMIZED STUDY

INTRODUCTIONBenign prostatic hyperplasia (BPH) is a very common illness affecting aged men, about half of patients will at some time need surgical intervention.Monopolar TURPis considered as the gold standard for the surgical treatment of BPH. Multiple studies showed higher complication rates in M-TURP operations in patients with large prostate volumes. The risk of hemorrhage is also higher specially in patients with blood disorders. Bipolar TURP, an electric current completes its circuit outside the body of the patients. This permits the use of saline as irrigating fluid, preventing the TUR syndrome and hyponatremia. Addionally B-TURP is associated with less bleeding and less operative time.The incidence of urethral stricture after transurethral resection of prostate (TURP) ranges from 2.2 to 9.8%. Most of the cases occurs within 6 months of transurethral surgery. Presentation is likely with weak flow, infection or acute urinary retention.The exact etiology of urethral stricture after TURP is still unknown. Suggested causes after TURP include infection, mechanical trauma, prolonged indwellingcatheter time,local anesthesia, and electrical injury.

S2071 Refractory Benign Esophageal Stricture - Management Dilemma

Introduction: Benign esophageal strictures can result from long-standing GERD, ablative or radiation therapy, caustic ingestion and etc. Management of strictures could be very challenging. We describe a case of a refractory esophageal stricture with aim to focus on management challenges. Case Description/Methods: A 36-year-old Indian female with a history of esophageal strictures secondary to caustic ingestion present to our GI clinic with complaints of worsening dysphagia to solids. She underwent multiple serial endoscopies with dilatation at an outside facility and subsequently was performing self-dilatation with bougie dilators, until no further relief of her symptoms. An esophagram revealed a narrow caliber mid and distal esophagus with 3 prominent stricture points. The proximal stricture could not be traversed on initial endoscopy with 9.9 mm gastroscope, therefore a 4.9 mm bronchoscope was used to assess the size and location of the 3 esophageal strictures which were noted at 25 cm, 30 cm and 35 cm from incisors. Serial dilations were performed with a CRE balloon dilator and triamcinolone injection at the refractory stricture site post dilation. The esophageal strictures were able to be dilated with serial dilatations and the gastroscope was able to traverse all 3 strictures without difficulty and patient experienced symptomatic relief. Patient was counseled regarding high risk of perforation with subsequent dilatation and given surgical consultations for second opinion and alternative management options. Discussion: Late management of caustic strictures makes dilatation more complex owing to fibrosis in esophageal wall. Perforation rates for caustic strictures is higher than standard benign stricture dilatation with anything from 0.4 up to 32% recorded in the literature. Refractory strictures are more common in caustic ingestion and the management has been reported with intralesional steroid injection or topical mitomycin C at the time of dilatation, and temporary stent placement. Prior to dilatation one must consider the following prior to endoscopically dilating such as etiology of stricture, degree of patient’s dysphagia, length, tortuosity and luminal diameter of the stricture. Our patient’s strictures were refractory to dilatation and intralesional steroid use. Stent placement is technically not feasible given different size and diameter of strictures as it enhances risk of perforation. Surgery although a high-risk approach but remains as curative resort for such cases.

A ureteral stricture disease score and classification system: correlation with upper urinary tract reconstructive surgery complexity.

BackgroundTo develop an original and standardized ureteral stricture disease (USD) score and classification system for quantifying ureter stricture characteristics, assessing complexity of the minimally invasive upper urinary tract reconstructive (UUTR) surgical procedure, formulating preoperative plans, and offering objective comparisons of surgical techniques between different institutions and surgeons.MethodsWe retrospectively reviewed a test set of 64 patients and a validation set of 170 patients who underwent minimally invasive UUTR surgery from January 2018 to January 2021. Three factors were selected to be included in the USD score and classification system: (I) stricture etiology (E, 1–2 points); (II) stricture segment (S, 0–3 points); and (III) length of stricture (L, 1–5 points). The UUTR surgery involves low-complex surgeries (cystoscopy with ureteral dilation and stent placement, ureteropyeloplasty, end to end repair, ureteral reimplantation) and high-complex surgeries (onlay repair (buccal mucosae, lingual mucosae, appendix mucosae), Boari flap repair and ileal ureter replacement). Estimated blood loss and operative time were used as surrogate indicators of surgical complexity.ResultsThe interrater reliability of the USD score and classification system was 0.908. A linear relationship between the USD score and estimated blood loss was observed (rs =0.676, P<0.001). The USD score was also correlated with operative time (rs =0.638, P<0.001). A significant difference in USD scores was found between the high and low complexity surgery groups (4 vs. 7, P<0.001). Variability of UUTR surgery is based on USD classification system, but with regularity to conform to.ConclusionsThe USD score and classification system is a concise, easily applicable, and validated scale to delineate the clinically significant features of ureter stricture that correlate with the complexity of the UUTR surgical procedure. The use of this score and classification system can facilitate preoperative plan and comparison of USD treatments in clinical practice and urological literature. Research with large sample is needed to further examine and modify the use of the system.

AUTHOR REPLY

Heterogeneity remains common in the field of reconstructive urology particularly with respect to peri-operative practice patterns. It has been argued that reconstructive urology may not be amenable to randomized trials due to variability in disease presentation, stricture etiologies, patient comorbidities, and the wide range of surgical techniques intrinsic to the “art” of reconstructive surgery. Despite these difference between centers, many aspects of reconstructive urology are likely amenable to meaningful randomized prospective study.

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

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

MP56-13 PATIENT-PERCEIVED CHANGES IN PENILE APPEARANCE POST-URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-13 PATIENT-PERCEIVED CHANGES IN PENILE APPEARANCE POST-URETHROPLASTY Dylan Hoare, Jordan Bekkema, and Keith Rourke Dylan HoareDylan Hoare More articles by this author , Jordan BekkemaJordan Bekkema More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Alterations in penile curvature or length post-urethroplasty are associated with patient dissatisfaction but are poorly described. This study aims to define the incidence and associations of patient-reported penile curvature and shortening after urethroplasty. METHODS: From 2011-2018, 387 patients completed enrollment in a prospective single-centre study assessing patient-reported outcomes pre-operatively and 6-months post-urethroplasty. Primary outcomes of perceived penile shortening and curvature were assessed at 6-months follow-up. Descriptive statistics were used to summarize findings while univariate and multivariate binary logistic regression was used to identify associations between loss of penile length or chordee with other clinical factors. RESULTS: Of the 387 patients, mean age was 49.5 years with mean stricture length of 4.5 cm. Postoperatively, 12.7% of patients perceived penile curvature (8.0% “somewhat”, 4.7% “severe”) and 22.8% of patients perceived penile shortening (14.5% “somewhat”, 8.3% “a lot”). Multivariate binary logistic regression identified stricture location (p=0.02) to be associated with perceived curvature while prior urethroplasty (p=0.17), type of urethroplasty (p=0.08) and other factors were not. Specifically, penile (O.R. 4.27, 95% CI 1.56-11.68, p=0.005) and panurethral (O.R. 10.15, 95% CI 3.46-29.77, p<0.001) locations were independently associated with this outcome. In a multivariate model, panurethral strictures (O.R. 4.23, 95% CI 1.10-16.20, p=0.04) and hypospadias (O.R. 5.46, 95% CI 1.32-22.70, p=0.02) were associated with patient perceived shortening while other factors such as age (p=0.19), type of urethroplasty (p=0.14) and other stricture etiologies or locations were not. CONCLUSIONS: Clinically significant changes in penile appearance are more common post-urethroplasty than initially thought. Stricture location and etiology are important predictors of these patient-perceived changes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e974-e974 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dylan Hoare More articles by this author Jordan Bekkema More articles by this author Keith Rourke More articles by this author Expand All Advertisement Loading ...

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 ...

PD35-07 INTERMEDIATE OUTCOMES FOLLOWING ROBOTIC NONTRANSECTING URETERAL REIMPLANTATION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (PD35)1 Sep 2021PD35-07 INTERMEDIATE OUTCOMES FOLLOWING ROBOTIC NONTRANSECTING URETERAL REIMPLANTATION Brian W Chao, Jeremy R Slawin, Nabeel A Shakir, Srikar A Kuppa, Chinonyerem U Okoro, Robert Harrison, Nathan W Cheng, Michael D Stifelman, Daniel D Eun, and Lee C Zhao Brian W ChaoBrian W Chao More articles by this author , Jeremy R SlawinJeremy R Slawin More articles by this author , Nabeel A ShakirNabeel A Shakir More articles by this author , Srikar A KuppaSrikar A Kuppa More articles by this author , Chinonyerem U OkoroChinonyerem U Okoro More articles by this author , Robert HarrisonRobert Harrison More articles by this author , Nathan W ChengNathan W Cheng More articles by this author , Michael D StifelmanMichael D Stifelman More articles by this author , Daniel D EunDaniel D Eun More articles by this author , and Lee C ZhaoLee C Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002039.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic ureteroneocystostomy can be performed via nontransecting side-to-side anastomosis, which eschews ureteral transection to preserve distal vascularity. We have previously described our early experience with this technique and herein present updated outcomes. METHODS: A multi-institutional ureteral reconstruction database (CORRUS) was retrospectively reviewed for patients undergoing robotic nontransecting ureteral reimplantation. The primary outcome of interest was freedom from recurrent ureteral stenosis, determined via a combination of reported symptoms, imaging findings, and/or endoscopy. We also report the incidence of de novo vesicoureteral reflux (VUR), defined as flank pain with voiding, recurrent urinary tract infections (UTI), and/or pyelonephritis in the absence of ureteral obstruction. RESULTS: We identified 26 patients who underwent robotic nontransecting ureteroneocystostomy between 2015 and 2020. Demographic data, peri-, and postoperative outcomes are shown in Table 1. Distribution of stricture etiology was similar to that reported in the literature, with iatrogenic injury in 15/26 patients (57.7%) being most common. 9/26 patients (34.6%) had prior operative intervention, most commonly endoscopic (88.9%). Adjunctive Psoas hitch or Boari flap was performed in 9/26 (34.6%) patients. There were no intraoperative or immediate postoperative complications. Over a median follow-up of 21 months (IQR 12–30), two patients (7.7%%) developed recurrent stenosis. One patient (3.8%) now receives chronic stent exchanges; the other (3.8%) had obstructive imaging findings and awaits further operative planning. 10/26 patients (38.5%) reported symptoms suggestive of de novo VUR. Of these, five (19.2%) reported mild flank pain with voiding, not requiring analgesics. One patient (3.8%) reported no pain but had recurrent UTIs, managed with non-antibiotic prophylaxis. One patient (3.8%) had recurrent flank pain and pyelonephritis and later underwent revision non-refluxing reimplantation. CONCLUSIONS: Robotic nontransecting ureteral reimplantation is an efficacious reconstructive option for distal ureteral strictures, even in cases of iatrogenic injury and prior abdominopelvic radiation. Symptomatic de novo VUR may develop and can often be managed conservatively. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e591-e591 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian W Chao More articles by this author Jeremy R Slawin More articles by this author Nabeel A Shakir More articles by this author Srikar A Kuppa More articles by this author Chinonyerem U Okoro More articles by this author Robert Harrison More articles by this author Nathan W Cheng More articles by this author Michael D Stifelman More articles by this author Daniel D Eun More articles by this author Lee C Zhao More articles by this author Expand All Advertisement Loading ...

The outcomes of three buccal mucosal graft urethroplasty techniques in women with urethral stricture disease.

The purpose of this paper is to present the outcomes of three buccal mucosal graft (BMG) urethroplasty techniques in female patients with urethral strictures. We included all patients who had BMG urethroplasty for female urethral strictures (FUS) disease between January 2015 and June 2020. Patient age, comorbidities, stricture etiology, stricture length, the number of previous treatments, preoperative and postoperative uroflowmetry data, postvoid residual volumes, and the operation and postoperative course details were documented. A total of 34 patients were included in this study. There were 8 patients in vaginal-sparing inlay BMG, 12 for ventral onlay BMG, and 14 for Aybek-Zumrutbas (AZ) technique groups. The mean age of the study population was 56.1 years. The length of urethral strictures varied between one and 4.5 cm. All patients had a previous history of endoscopic treatment or dilatations. The preoperative mean maximal flow rate (Qmax) was 6.9 ml/s. The median postoperative follow-up time was 24.6 months. Twelve months after surgery, the mean Qmax was 25 (range: 14-32) ml/s. There were no significant complications in any patients. The success rates were 83.3% for ventral onlay BMG, 87.5% for vaginal-sparing, and 100% for AZ technique. All three BMG urethroplasty techniques applied in this study had a success rate of over 80% in a median follow-up of approximately 2 years. In females, urethroplasty with BMG provided high rates of cure, and the recently described two techniques (vaginal-sparing inlay BMG, and AZ technique) showed promise in FUS treatment.

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.

MALE URETHRAL STRICTURE CHARACTERISTIC IN DR KARIADI GENERAL HOSPITAL SEMARANG: A DESCRIPTIVE STUDY

Objective: This research was conducted to describe male urethral stricture characteristic in Kariadi General Hospital Semarang. Material &amp; Methods: The data is collected retrospectively from the male urethral stricture patient medical records Kariadi General Hospital Semarang between January 2013 until December 2017. The data is analyzed descriptively to describe the characteristics of male urethral stricture patients, patient age, etiology, site, definitive surgery, and complications. Results: Within the period, 171 patients with male urethral stricture. The mean age was 52.11 years (range 9-86). The causes of stricture were trauma in 145 patients (84.8%), infection in 25 patients (14.6%) and iatrogenic in 1 patients (0.06%). Strictures site were posterior in 146 patients (85.4%) and anterior in 25 patients (14.6%). The definitive surgery for strictures were from DVIU in 132 patients (77.2%) and urethroplasty in 39 patients (22.8%). Complications rate were recurrence of stricture 56 patients (32.74%), bleeding 6 patients (3.05%), extravasation 14 patients (8.18%), erectile dysfunction 4 patients (2.34%). Conclusion: Trauma is the leading cause of urethral stricture in Kariadi General Hospital. The most common definitive therapy for urethral stricture in Kariadi General Hospital was still DVIU, but there has been an increase for urethroplasty and we still get the learning curve for it.

The one-stage balloon dilatation with stone extraction for a combination of short urethral stricture and urethral stone in men

Introduction. The literature highlights isolated studies examining approaches to the treatment of patients with a combination of stones and urethral stricture. In this regard, the problem of creating optimal tactics for managing such patients remains relevant.Purpose of the study. To analyze of own experience in treating patients with a combination of stricture and urethral stone using balloon dilation with urethral stone extraction.Materials and methods. The study included 7 men with short urethral stricture and stone, who underwent balloon dilation with urethral stone extraction. The age of patients ranged from 47 to 65 years (median - 52 years). The length of the urethral stricture ranged from 3 to 10 mm (median - 7 mm). The stricture in 2 (28.6%) cases was localized in the penile part of the urethra and 5 (71.4%) in the bulbous part. An etiology of urethral strictures: traumatic - in 2 (42.9%) patients, inflammatory - in 1 (14.3%) of cases, idiopathic - in 4 (57.1%) of cases. All patients had 1 urethral stone. The sizes of the stone ranged from 4 to 9 mm (median - 6 mm).Results. The operation time ranged from 11 to 19 min (median - 13 min). No patient had any intraoperative complications. UTIs was observed in the early postoperative period in 1 patient. The duration of postoperative hospital stay ranged from 1 to 5 days (median - 3 days). Postoperative follow-up ranged from 3 to 24 months (median - 14 months). Only 1 (14.3%) patient had a recurrence of urethral stricture 18 months after treatment. Thus, the overall treatment success in this group of patients was 85.7% (6/7).Conclusion. We used this conjunction approach when combined stricture and urethral stone in men for the first time in the world. It seems quite promising given the results.

Long-term follow-up of two-sided dorsal plus ventral oral graft bulbar urethroplasty: single center experience on 216 patients.

Two-sided dorsal plus ventral oral graft urethroplasty is a new urethra-sparing technique suggested in tight bulbar strictures which are too severe for a simple one-side grafting. The aim of this study was to evaluate long-term outcomes and the success predictive factors of this technique. A descriptive retrospective study was conducted on 216 patients undergoing dorsal plus ventral graft urethroplasty for bulbar strictures between 2002 and 2018 in a single high-volume center by a single surgeon (EP). The primary outcome measure was stricture recurrence at follow-up. Surgical procedure was considered failed when any postoperative instrumentation was needed. Univariable and multivariable logistic regression analysis were performed. Median follow-up was 98 months (IQR: 41-131). Among the 216 patients, 188 (87%) were successful and 28 (13%) were failures. Most of the failures (78.4%) were observed during the first 7 years of follow-up, afterward failures were less frequently recorded. Stricture length <1.5 cm and the absence of previous treatments resulted as independent success predictors (respectively P=0.04, OR=0.55 (0.29-0.99) and P=0.02, OR=0.23 (0.06-0.79). Age and stricture etiology were not significant predictors of surgical outcome. The limitation of our survey is that it is a retrospective single center experience. Multicentric experiences from different centers should be performed. After long-term follow-up in our wide series, the two-sided dorsal plus ventral oral graft bulbar urethroplasty showed a high success rate. Stricture length <1.5 cm and the absence of previous treatments resulted as independent success predictors.