Incidence Of Urethral Stricture Research Articles

Incidence of urethral stricture in patients with urethral trauma: a 10-year experience in an Indonesian tertiary hospital

BACKGROUND Urethral injuries are rarely life-threatening but can cause significant morbidity if left untreated. Until now, data on urethral trauma incidence are still limited in Indonesia. This study aimed to report the incidence of traumatic urethral stricture within 10 years of experience in treating urethral trauma. METHODS This retrospective study used a total sampling method for all patients with urethral trauma who came to the emergency department and agreed to undergo radiological evaluation. Patient data were collected from January 2012 to December 2021. All patients were followed up for 3 months after trauma, and the incidence of urethral stricture was analyzed using the chi-square or Fisher's exact tests as an alternative. RESULTS The overall incidence of urethral stricture was 48.4%. Of 122 patients, 82.0% had anterior urethral trauma. Grade III American Association for the Surgery of Trauma (43.4%) was the most common urethral trauma. The cause of urethral trauma was iatrogenic, pelvic fracture urethral injury (PFUI), straddle injury, and penile fracture, contributing in 64.8%, 18.0%, 16.4%, and 0.8% of the cases, respectively. Most patients (70.5%) underwent a cystostomy catheterization procedure as initial treatment. Straddle injury, PFUI, and a higher degree of urethral trauma were significantly associated with urethral stricture formation (p<0.05). CONCLUSIONS Straddle injury, PFUI, and a higher degree of urethral trauma were significantly related to a higher incidence of urethral stricture. Most low-grade and anterior urethral traumas can resolve spontaneously.

Incidence and management of BPH surgery-related urethral stricture: results from a large U.S. database.

Urethral stricture (US) is a well-known complication after surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to evaluate the contemporary incidence of the US after different types of BPH surgery, to identify associated risk factors and to assess its management. A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing de-identified patient records compiled between 2011 and 2022. Specific International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population characteristics and outcomes. All the most employed surgical procedures for BPH treatment were considered. Multivariable logistic regression was employed to evaluate factors associated with diagnosis of post-operative US. Among 274,808 patients who underwent BPH surgery, 10,918 developed post-operative US (3.97%) within 12 months. Higher incidence of US was observed following TURP (4.48%), Transurethral Incision of the Prostate (TUIP) (3.67%), Photoselective Vaporization of the Prostate (PVP) (3.92%), HoLEP/ThuLEP (3.85%), and open Simple Prostatectomy (SP) (3.21%). Lower incidence rates were observed after laparoscopic\robot-assisted SP (1.76%), Aquablation (1.59%), Prostatic Urethral Lift (PUL) (1.07%), Rezum (1.05%), and Prostatic Artery Embolization (PAE) (0.65%). Multivariable analysis showed that patients undergoing PUL, Rezum, Aquablation, PAE, and PVP were associated with a reduced likelihood of developing US compared to TURP. US required surgical treatment in 18.95% of patients, with direct visual internal urethrotomy (DVIU) and urethroplasty performed in 14.55% and 4.50% of cases, respectively. Urethral dilatation (UD) in an outpatient setting was the primary management in most cases (76.7%). The present analysis from a contemporary large dataset suggests that the incidence of US after BPH surgery is relatively low (<5%) and varies among procedures. Around 94% of US cases following BPH surgery are managed using minimally invasive treatment approaches such as UD and DVIU.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

ObjectiveTo investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. MethodsOne hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. ResultsA total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. ConclusionIntra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

The Case Study of Pre-operative Transurethral Resection of Benign Prostatic Hyperplasia

Objective: The case study of pre-operative transurethral resection of benign prostatic hyperplasia&#x0D; Methods: The total of 987 patients with BPH in our hospital from September 2016 to December 2019 was selected, all of whom underwent TURP, and the rate and reason for reoperation of all patients were observed.&#x0D; Results: Among the 987 BPH patients, a total of 46 cases underwent resection, and the rate was 4.66%; compared with patients with one operation, the amount of postoperative wound bleeding was greater than that of patients with one operation, and the incidence of urethral stricture and bladder neck contracture was higher than that of patients with one operation. Statistically significant (P&lt;0.05).&#x0D; Conclusion: The re-operation rate of BPH patients after TURP is low, but there are still some patients with recurrence. The main reasons Including urethral stenosis, residual glands, postoperative wound bleeding, and bladder neck contracture. At the same time, implementing targeted preventive measures in combination with the above reasons can effectively reduce the risk of repeated electrocardiography. Ratio of surgical resection and improved long-term prognosis.

Effect of Prolonging the Duration of Stenting on Urethral Stricture in Proximal Hypospadias with Severe Curvature Repair: A Prospective Cohort Study.

The aim of this study was to evaluate whether prolonged stenting reduces the risk of urethral stricture after proximal hypospadias (PH) with severe curvature (SC) repair. We prospectively studied a cohort of patients with PH with SC repair who underwent urethral plate transection and urethroplasty between January 2010 and December 2020. According to the duration of stenting, the patients were divided into 2-, 4-, and 6-week groups. Postoperative complications and time of urethral stricture occurrence were analyzed. In total, 665 patients were included in the analysis. The overall incidence of complications was 26.6% (n = 177), including 42 cases of urethral strictures: 27 (64.3%) cases of urethral stricture occurred between 4 and 6 weeks after urethroplasty, 7 cases occurred between 7 weeks and 6 months after urethroplasty, 7 cases occurred more than 6 months after urethroplasty, and 1 case occurred at 3 weeks after urethroplasty. The incidence of urethral stricture in the 6-week group (1.8%) was significantly lower than that in the 4- (5.8%) and 2-week groups (10.9%) (p < 0.05). Prolonged stenting reduces the risk of urethral stricture in PH with SC repair. Four to six weeks after PH with SC repair may be the key period for the formation of early urethral strictures.

Analysis of The Curative Effect of Tubularized Incised Plate Urethroplasty for Distal Hypospadias With The Dysplastic Corpus Spongiosum Covering Technique.

To investigate the use of tubularized incised plate (TIP) urethroplasty for distal second- and third-degree hypospadias to free the dysplastic forked corpus spongiosum and Buck's fascia, which are used as a covering material for the new urethra, thereby reducing the incidence of urinary fistula and other complications in the coronal sulcus. Clinical data of 113 patients with distal hypospadias treated with TIP urethroplasty from January 2017 to December 2020 were retrospectively analyzed. The study group comprised 58 patients (use of dysplastic corpus spongiosum and Buck's fascia to cover the new urethra), and the control group comprised 55 patients (use of dorsal Dartos fascia to cover the new urethra). All children were followed up for more than 12 months. In the study group, 4 patients developed urinary fistulas, 4 developed a urethral stricture, and no case developed glans fissure. In the control group, 11 patients developed urinary fistulas, 2 developed a urethral stricture, 3 developed a glans cracking. Using the dysplastic corpus spongiosum to cover the new urethra increases the amount of tissue in the coronal sulcus and reduces the incidence of urethral fistula, but it may increase the incidence of urethral stricture.

MP13-13 WOLF 24F VS. STORZ 28F LASER SCOPE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP): INTERIM ANALYSIS OF A PROSPECTIVE RCT

You have accessJournal of UrologyCME1 Apr 2023MP13-13 WOLF 24F VS. STORZ 28F LASER SCOPE FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP): INTERIM ANALYSIS OF A PROSPECTIVE RCT Nick Dean, Matthew Lee, Mark Assmus, Jenny Guo, Jessica Helon, and Amy Krambeck Nick DeanNick Dean More articles by this author , Matthew LeeMatthew Lee More articles by this author , Mark AssmusMark Assmus More articles by this author , Jenny GuoJenny Guo More articles by this author , Jessica HelonJessica Helon More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is routinely performed with a 24, 26, or a 28 French (F) laser scope. Proponents of the 28F scope state that larger sheath size allows for superior flow and visibility leading to a more efficient operation and better hemostasis. Those utilizing the 24F scope suggest the smaller size is less traumatic, resulting in a lower incidence of urethral strictures and temporary incontinence. We sought to compare outcomes of HoLEP using the 24F and 28F laser scope. METHODS: From May 2022 to October 2022, we prospectively randomized 59 patients with prostates 200 cm3 or less undergoing HoLEP 1:1 to either a 24F or 28F laser scope. IRB approval (STU00215646) and registry with ClinicalTrials.gov (NCT05308017) was obtained. The primary outcome was differences in surgical duration between groups (mins). Secondary outcomes included surgeon scope evaluation (flow rate, visualization, and intra-operative complications) and post-operative patient outcomes. RESULTS: There was no difference in demographics and prostate features between patients randomized to 28F (n=30) versus 24F (n=29) (p>0.05). Intra-operative variables including procedure, enucleation, and morcellation time (s), as well as OR specimen weight (g), and enucleation efficiency (g/min) were not different between groups (all p>0.05). The 28F scope was associated with improved surgeon-graded flow and visualization (p<0.01); however, there was no difference in intra-operative complications (p=0.48). Successful same day catheter removal occurred in 48/54 (89%) patients with no statistical difference between groups (24F 81% versus 28F 96% p=0.09). Time to complete continence was statistically shorter in the 24F group (5.8 versus 15.2 days, p=0.04). Time to resolution of hematuria (5.0 versus 6.4 days, p=0.33) and dysuria (4.8 versus 4.0 days, p=0.65) was not different between groups. There were no differences in presence of hematuria, incontinence, and dysuria between groups at one and three-month patient surveys. There were no major complications (CD>3b), urethral strictures, or bladder neck contractures in either group during the follow-up period. CONCLUSIONS: The 28F laser scope was associated with improved surgeon gradings. There were no statistically significant differences in intra-operative or post-operative outcomes at 1 and 3-month follow up due to scope size; however, in the immediate postoperative period the 24F scope may lead to earlier return of continence. Source of Funding: Richard Wolf © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e178 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nick Dean More articles by this author Matthew Lee More articles by this author Mark Assmus More articles by this author Jenny Guo More articles by this author Jessica Helon More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF downloadLoading ...

One-stage repair of proximal hypospadias by in situ tubularization of the transverse preputial island flap

PurposeThis study aimed to compare the efficacy of modified transverse preputial island flap (TPIF) repair with the traditional TPIF procedure and Byar’s two-stage procedure in proximal hypospadias repair, especially in the postoperative urethral stricture incidence rates.Materials and methodsPatients admitted for proximal hypospadias treated with modified TPIF repair, the traditional TPIF procedure, or Byar’s two-stage procedure at our institution from 2017 to 2021 were identified, and the incidence of postoperative complications among them was compared.ResultsIn total, 142 patients were included (modified TPIF group, 43; traditional TPIF group, 37; and Byar’s two-stage group, 62). The length of the neourethra was 4.21 ± 0.63 cm in the modified TPIF group, 4.18 ± 0.71 cm in the traditional TPIF group, and 4.20 ± 0.68 cm in the Byar’s two-stage group. The rate of urethral stricture in the modified TPIF group (two cases, 4.65%) was significantly lower than that in the traditional TPIF group (four cases, 10.81%) (P = 0.008). Seven (16.28%) cases of urethrocutaneous fistula occurred in the modified TPIF group, six (16.22%) in the traditional TPIF group, and eight (12.90%) in the two-stage group. Additionally, one case (2.33%) of urethral diverticulum occurred in the modified TPIF group, one (2.70%) in the traditional TPIF group, and three (4.84%) in Byar’s two-stage group.ConclusionsModified TPIF repair can ensure a wedge anastomosis between the proximal urethral meatus and the neourethra, provide support and blood supply for the neourethra. Furthermore, it extended the urethral plate width at the anastomosis and urethral meatus, effectively reducing the incidence of urethral strictures.

Surgical management of stricture urethra in patients with chronic renal failure: Ten years' experience at a tertiary center

Patients suffering from stricture urethra and deranged renal function have poor quality of life. The incidence of urethral stricture co-existing with renal failure is comparatively small and cause may be multifactorial. There is paucity of literature on management of urethral stricture associated with deranged renal function. We present our experience of managing stricture urethra associated with chronic renal failure. This was a retrospective study conducted from 2010 to 2019. Patients with stricture urethra and deranged renal function (serum creatinine >1.5 mg/dl) who underwent urethroplasty or perineal urethrostomy were included in our study. A total of 47 patients met the inclusion criteria and were included in this study. Patients were followed every 3 months in their 1st year of surgery and 6 monthly thereafter. Statistical analysis was done using SPSS version 16. There was a significant increase in the mean postopérative maximum and average urinary flow rates when compared to the preoperative values. The overall success rate was 76.59%. Out of 47 patients, 10 had wound infection and delayed wound healing, 2 patients developed ventricular arrhythmias, 6 patients developed fluid and electrolyte imbalance, 2 patients developed seizures, and 1 patient developed septicemia in the postoperative period. Prevalence of patients with chronic renal failure associated with stricture urethra was 4.58% and features suggestive of deranged renal function at presentation were present in 1.81% patients. In the present study, complications related with chronic renal failure occurred in 17 (36.17%) patients. Multidisciplinary care of the patient along with appropriate surgical management is a viable option in this sub-group of patients.

Urethral Complications Post-Holmium Laser Enucleation of the Prostate: A Seven-Year Experience.

Background: Urethral strictures (US) and bladder neck contracture (BNC) are troublesome complications of transurethral surgery. We aimed to report the incidence, risk factors, and management of US and BNC post-holmium laser enucleation of the prostate (HoLEP) together with review of literature. Patients and Methods: A retrospective review of prospectively managed HoLEP patients in one institution between 2015 and 2021 was performed. The study included patients with complete follow-up of at least 1-year. Multivariate regression analysis for risk factors of US or BNC was performed. Appropriate statistical analysis methods were used. Results: Out of total 1055 HoLEP patients, 566 patients were included. Eleven (1.94%), 8 (1.41%), and 1 (0.17%) patients developed US, BNC, and both, respectively, while 8 (1.41%) patients had postoperative recurrence of intraoperatively diagnosed US. With multivariate regression analysis, intraoperative US (p = 0.0055, odds ratio [OR] = 15.5, confidence interval [95% CI] = 2.2-37.7), intraoperative need for meatotomy (p = 0.0019, OR = 7.69, 95% CI = 2.12-27.8), and longer operative time (p = 0.0250, OR = 1.043, 95% CI = 1.005-1.083) were predictors of US/BNC. For US patients, urethral dilatation under local anesthesia was sufficient in 14 (70%) patients while 6 (30%) patients had visual urethrotomy. Patients with BNC were managed by endoscopic bladder neck incision. Conclusion: Although the US/BNC are annoying long-term sequalae that may complicate HoLEP, the incidence is still low and can be easily managed. Diagnosed intraoperative stricture, need for meatotomy, and longer operative time are the main predictors of urethral complications post-HoLEP.

The incidence of urethral stricture and bladder neck contracture with transurethral resection vs. holmium laser enucleation of prostate: A matched, dual-center study.

Urethral strictures (US) and bladder neck contracture (BNC) are common, long-term complications of transurethral prostate surgery. We aimed to compare transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) regarding incidence of US or BNC and identify possible risk factors. A retrospective review of patients who underwent TURP and HoLEP with followup data of at least one year in two separate institutions was performed. The incidence of postoperative US or BNC in both groups was compared. Bivariate and multivariate analysis of risk factors in both cohorts with US or BNC were performed. The study included 208 patients: 101 and 107 patients in the TURP and HoLEP arms, respectively. The two groups were matched for age and prostate size. Eight (7.92%) and five (4.72%) patients in the TURP and HoLEP arms, respectively, developed US (p=0.3423), while two (1.87%) patients in the HoLEP arm had BNC (p=0.2634). Of the eight patients with the US in the TURP arm, six (9.8%) had bipolar TURP, while two (5%) had monopolar TURP. Multivariate analysis showed that larger prostate volume (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.05, 1.41, p=0.0066) and longer operative time (HR 1.84, 95% CI 1.76, 1.93, p=0.0015) were associated with risk of US/BNC. There is no significant difference between TURP and HoLEP regarding incidence of US or BNC, although there is a tendency towards a higher rate of US associated with bipolar TURP. Increased prostate volume and operative time are possible risk factors.

MP04-06 INCIDENCE OF URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROSPECTIVE, RANDOMIZED TRIALS

You have accessJournal of UrologyCME1 May 2022MP04-06 INCIDENCE OF URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROSPECTIVE, RANDOMIZED TRIALS Ee Jean Lim, Vineet Gauhar, Giacomo Maria Pirola, Emanuele Rubilotta, Marcelo Langer Wroclawski, Dong Le Quy, Marilena Gubbiotti, Vinson Wai, Shun Chan, Mariela Corrales, Esther Garcia Rojo, Thomas R.W. Herrman, Jeremy Yuen, Chun Teoh, Hong Kong, and Daniele Castellani Ee Jean LimEe Jean Lim More articles by this author , Vineet GauharVineet Gauhar More articles by this author , Giacomo Maria PirolaGiacomo Maria Pirola More articles by this author , Emanuele RubilottaEmanuele Rubilotta More articles by this author , Marcelo Langer WroclawskiMarcelo Langer Wroclawski More articles by this author , Dong Le QuyDong Le Quy More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Vinson WaiVinson Wai More articles by this author , Shun ChanShun Chan More articles by this author , Mariela CorralesMariela Corrales More articles by this author , Esther Garcia RojoEsther Garcia Rojo More articles by this author , Thomas R.W. HerrmanThomas R.W. Herrman More articles by this author , Jeremy YuenJeremy Yuen More articles by this author , Chun TeohChun Teoh More articles by this author , Hong KongHong Kong More articles by this author , and Daniele CastellaniDaniele Castellani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture (US) is a well-known long-term complication of endoscopic procedures for benign prostatic hyperplasia (BPH). This systematic review aims to evaluate the incidence and influencing factors of US in relation to different surgical endoscopic techniques for treating clinical BPH. METHODS: We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The PICOS (Patient Intervention Comparison Outcome Study type) model was used to frame and answer the clinical question. The incidence of urethral stricture was estimated by comparing the results of the studies that used different endoscopic techniques. Patients were assigned in groups according to the type of surgery and regardless of energy used (enucleation, ablation and resection group). The incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. Analyses were two-tailed, and the significance was set at p <0.05 and a 95% CI. Study heterogeneity was assessed utilizing the I2 value. Substantial heterogeneity was defined as an I2 value >50% or a Chi2 p-value <0.10. RESULTS: A total of 80 studies were included for meta-analysis. There was no significant heterogeneity among the studies, with an I2 0%, Chi2 16.98, p=0.88 for Enucleation vs TURP studies and I2 0%, Chi2 27.71, p=0.99 for the Ablation vs TURP ones. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p=0.004). US incidence was lower for Ablation procedures than after TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p=0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p=0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p=0.004). The mean postoperative catheterization was significantly shorter in laser treatments than in TURP also potentially influencing US incidence. CONCLUSIONS: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e59 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ee Jean Lim More articles by this author Vineet Gauhar More articles by this author Giacomo Maria Pirola More articles by this author Emanuele Rubilotta More articles by this author Marcelo Langer Wroclawski More articles by this author Dong Le Quy More articles by this author Marilena Gubbiotti More articles by this author Vinson Wai More articles by this author Shun Chan More articles by this author Mariela Corrales More articles by this author Esther Garcia Rojo More articles by this author Thomas R.W. Herrman More articles by this author Jeremy Yuen More articles by this author Chun Teoh More articles by this author Hong Kong More articles by this author Daniele Castellani More articles by this author Expand All Advertisement PDF DownloadLoading ...

Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair.

BackgroundUrethrocutaneous fistula is one of the most common complications arising from hypospadias surgery. The purpose of our study was to investigate the effectiveness and safety of allogeneic human acellular dermal matrix (HADM) application as a means of preventing the occurrence of urethrocutaneous fistula following hypospadias surgery.MethodsThis is a non-randomized study of 219 cases (out of 270 patients with hypospadias) which satisfied inclusion and exclusion criteria. These patients were divided into two groups: 101 HADM patients, and 118 control patients (who did not receive HADM). In the control group, 77 boys were treated by single-stage urethroplasty (TIP) and 41 underwent staged urethroplasty (Thiersch-Duplay). In the HADM group, 59 boys underwent the TIP and 42 underwent the Thiersch-Duplay. In the postoperative period, we recorded the incidence of infection, urethrocutaneous fistula, and urethral stricture complications in these two groups of patients. The effectiveness and safety of HADM in preventing urethrocutaneous fistula following hypospadias surgery were evaluated according to these indicators.ResultsIn the control group, following the operation there were 16 cases of infection, 38 cases of urethrocutaneous fistula after extubating, and 5 cases of urethral stricture. In the HADM group, there were 19 cases of postoperative infection, 12 cases of urethrocutaneous fistula after extubating, and 5 children with urethral stricture. In comparing the two groups, it was found that the postoperative infection rate (13.6 vs. 18.8%) and the incidence of urethral stricture (4.2 vs. 5.0%) were not statistically significant (P > 0.05), while the postoperative urethrocutaneous fistula rate (32.2 vs. 11.9%) was statistically significant (P < 0.001).ConclusionIt is found that HADM application can significantly reduce the incidence of urethrocutaneous fistula complications, without increasing the risk of infection and urethral stricture.

Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials.

This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12months after surgery (RR 0.51 95% CI 0.33-0.81, p = 0.004). The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.

Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study.

Introduction:Bipolar transurethral resection of the prostate (B-TURP) is a commonly performed procedure, although it has not yet surpassed the gold standard monopolar TURP. The incidence and contributing factors to the development of urethral stricture following B-TURP are still a matter of debate and were analyzed in the present study.Methods:This prospective study evaluated patients who underwent B-TURP. Demographic characteristics, clinical data, and data on other specific investigations were analyzed. B-TURP was performed using an Olympus TURis bipolar system. Patients were followed up for 6 months with the International Prostate Symptom Score (IPSS), peak flow rate (Q-max), and residual urine estimation. Urethral stricture was defined as narrowing of the urethral lumen requiring instrumentation to improve the urinary flow rate.Results:A total of 352 patients were enrolled, with a mean age of 67 ± 8.6 years. The mean preoperative IPSS, prostate volume, and Q-max were 21 ± 4, 58.8 ± 31.7 cm3, and 8 ± 3 mL/sec, respectively. The mean meatal caliber was 28 ± 2 Fr. In 209 patients (59.4%), B-TURP was performed using a 24-Fr resectoscope, while in the remaining 143 (40.6%), a 26-Fr resectoscope was used. The mean resection times with the 24-Fr and 26-Fr resectoscopes were 36.5 ± 19.8 min and 63.5 ± 30 min, respectively. Urethral strictures were identified in 15 patients, with an incidence of 4.3%. Mean meatal caliber was significantly related to the risk of stricture formation (P = 0.001).Conclusions:The incidence of urethral stricture after B-TURP was 4.3%. We found that small meatal caliber was associated with an increased risk of urethral stricture following B-TURP.

Author reply Re: Mannem SR, Mallikarjuna C, Bhavatej E, Taif NB, Ravichander O, Syed MG. Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study. Indian J Urol 2022;38:146-50.

Author reply Re: Mannem SR, Mallikarjuna C, Bhavatej E, Taif NB, Ravichander O, Syed MG. Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study. Indian J Urol 2022;38:146-50.

Re: Mannem SR, Mallikarjuna C, Bhavatej E, Taif NB, Ravichander O, Syed MG. Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study. Indian J Urol 2022;38:146-50.

Re: Mannem SR, Mallikarjuna C, Bhavatej E, Taif NB, Ravichander O, Syed MG. Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study. Indian J Urol 2022;38:146-50.

Calibre of the External Urethral Meatus in Indian Population: A Cross-sectional Study

Introduction: Transurethral resection instruments are designed as per western standards and are often found to be larger for Indian patients, leading to urethral trauma during instrumentation or higher incidence of urethral strictures postoperatively. Aim: To assess and record the calibre of the External Urethral Meatus (EUM) among Indian male and female population. Materials and Methods: This cross-sectional study was done at a tertiary health care centre over a period of one and half years from July 2016 to December 2017. All male and female patients above the age of 12 years undergoing lower urinary tract instrumentation at the institute underwent assessment for EUM calibre. A total of 1,127 males and 182 females were enrolled in the study. Descriptive statistics (mean, Standard Deviation, and range) were performed for age, height and the EUM in males and females. Linear regression analysis was used to analyse the correlation between EUM calibre and age; and EUM calibre and body height. The correlation was considered statistically significant when p&lt;0.05. Results: The mean EUM calibre of the male population was observed to be 23.23±1.60 Fr and that of the female population was 23.58±2.00 Fr. On linear regression analysis, a significant but weak correlation was found between EUM calibre and body height in male (R2 value: 0.024, p-value&lt;0.0001). On the other hand, no correlation was observed between EUM calibre and body height in females (R2 value: 0.009, p-value= 0.196). Conclusion: The average calibre of the EUM in Indian males was 23.23 Fr which is about 3 Fr smaller than the standard transurethral resectoscope sheath. Thus, use of larger sized sheaths may result in urethral stricture in narrow calibre urethra.

Risk Factors for Early Urethral Stricture After Mono-Polar Transurethral Prostate Resection: A Single-Center Experience.

AimThis study aimed to investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and the risk factors affecting the development of urethral stricture in patients treated in our clinic.Material and methodsThis retrospective study included patients who underwent TURP due to benign prostate hyperplasia (BPH) and had complete postoperative follow-up data of at least 12 months. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between urethral stricture and eight parameters (age, body mass index [BMI], prostate volume, number of comorbidities, amount of tissue removed, operative time, perioperative blood loss, and catheterization duration).ResultsOf the 3069 patients who underwent TURP in our clinic during the study period, 1740 patients with complete clinical data were included in the study. Mean age was 67.83 ± 5.80 years and mean body mass index (BMI) was 27.63 ± 4.31 kg/m2. Median preoperative prostate volume was 50.0 (range, 41.0-62.0) mm3 and the average amount of tissue removed during surgery was 20.0 (range, 12.0-30.0) g. Urethral stricture was detected in 3.9% (67/1740) of the patients during a minimum of 12 months of follow-up period after TURP. In multivariate analysis, prolonged operative time and high comorbidity burden were found to be risk factors for urethral stricture (p<0.001 for both).ConclusionEarly urethral stricture remains an important complication of TURP. Our results show that prolonged operative time and high comorbidity burden are factors that increase the risk of urethral stricture.

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.