Internal Urethrotomy Research Articles

Which Are the Commonest Sites and Characteristics of Post-Transurethral Prostate Surgery Strictures in a High-Volume Reconstructive Center?

Background: Urethral stricture is a well-known complication after transurethral prostate surgery (TPS) and it is usually considered an easy-to-treat condition. We aimed to examine characteristics of post-TPS urethral stricture cases that were referred for urethroplasty at our tertiary center. Methods: We identified 201 patients with TPS-induced stricture treated with urethroplasty at our institution from 2017 to 2021. First, stricture length and location were evaluated during preoperative assessment. Second, multiple sets of multivariable logistic regression (MLR) analyses were run to assess whether clinical variables were associated with the location of the stricture. Results: Median stricture length was 5 cm (4-7). One hundred forty-one (70.1%) patients received previous no-invasive treatments (dilatation and/or direct visual internal urethrotomy). Proximal bulbar urethra was the commonest site for stricture, whereas panurethral stricture (≥10 cm) was diagnosed in 41 (20.4%) patients. Lichen sclerosus was more common in patients with penile stricture location, compared with patients with other involved segments (26% vs 19%, p = 0.03), and it was the only predictor of penile and midbulbar urethra location at MLR. Surgical approaches were augmented urethroplasty in 94% of patients, especially for patients with previous treatment including urethroplasty (95.8% vs 82.5% for naive, p = 0.004). Dorsal onlay was the preferred approach for bulbar (53.4%) and penile urethra (90.7%), whereas ventral onlay (38.2%) and double face augmentation (20.6%) were the preferred approaches in membranous strictures. Conclusions: Most patients who were referred for TPS-induced stricture attempted previous noninvasive managements. Referred TPS-induced urethral strictures were long and frequently involving multiple segments of urethra. Augmentation urethroplasty was our preferred surgical approach because of the characteristics and complexity of these strictures. The presence of lichen may increase the risk of post-TPS stricture in a specific segment of urethra, namely the penile and midbulbar urethra.

Anastomotic Urethroplasty with Double Layer Continuous Running Suture Re-Anastomosis Versus Interrupted Suture Re-Anastomosis for Infective Bulbar Urethral Strictures: A Prospective Randomised Trial.

Introduction: The objective of this study was to compare a double-layer running suture re-anastomosis urethral stricture repair with early catheter removal to the conventional interrupted suture re-anastomosis after excision of a bulbar urethral stricture. Methods: A consecutive series of patients with bulbar urethral stricture were enrolled in the study. The patients were randomized into two groups according to an odd/even serial number distribution. Patients’ medical records were analyzed for demographics, stricture characteristics, and lower urinary tract obstructive symptoms. The outcomes were based on the presence/absence of obstructive voiding symptoms, and retrograde urethrography (RGU) performed on the first post-operative day in Group 1 and in both groups (Groups 1 and 2) at six weeks after surgery. Flexible urethroscopy was only performed on specific cases where RGU was unclear both pre- and post-operatively or when clinical recurrence was suspected. The minimum follow-up (FU) was 18 months. Success was defined as no need for subsequent dilatation, direct vision internal urethrotomy (DVIU), or urethroplasty. Results: A total of thirty-six patients with a mean age of 45 years (range 20 to 69 years) with bulbar urethral stricture were included in this study. Group 1 and Group 2 included 19 and 17 patients, respectively. Two patients were lost during randomization and subsequently to FU. The average stricture lengths were comparable between the two groups according to the retrograde urethrogram: 1.20 cm (range 0.6 to 2) in Group 1 and 1.27 cm (range 0.5 to 2.4) in Group 2, respectively (p = 0.631). The success rate for Group 1 was 90% after a mean follow-up of thirty-six months (range 20 to 40), which was clinically significant compared to the 71% in Group 2 after a mean FU of thirty-three months (range 19 to 40; p = 0.0218; 95% CI: 0.462–41.5766). Conclusions: Anastomotic urethroplasty (AR) performed with a double layer re-anastomosis had a cure rate comparable to the conventional anastomosis with interrupted sutures after a follow-up of eighteen months and longer. The urethral catheter can be safely removed within twenty-four hours after the excision of stricture and double-layer re-anastomosis.

Referral patterns, clinical features and management of uncorrected hypospadias in a series of adult men

Hypospadias surgery undertaken in early life often continues to impose challenges as patients age. Little is known about the natural history of uncorrected hypospadias persisting into adulthood. To describe presenting symptoms and management strategies in men with uncorrected hypospadias referred to our national tertiary transitional clinic for congenital urological conditions. Patients with uncorrected hypospadias older than 16 years at the time of referral were identified by searching the electronic patient record system for ICD-10 hypospadias codes. Data were extracted over a 10-year period according to a predefined protocol. Among 201 referrals, 65 men with hypospadias (glanular n=12, coronal n=26, subcoronal n=9, corporal n=4, penoscrotal n=2 and MIP n=12) had never previously had reconstructive surgery undertaken. Obstructive symptoms predominated (n=30) and the risk of symptoms increased with advancing age (Figure). Presenting complaints varied across the age span; cosmetic issues (n=11) and coital pain (n=5) were primarily seen in youth as opposed to urinary obstructive symptoms that were increasingly more frequent with age (p=0.002) (Figure). Management included reconstructive surgery (n=24), minor procedures (preputioplasty, circumcision, meatoplasty, dilatation/urethrotomy, total n=28) as well as counselling (n=12). The management strategies were independent of age and hypospadias type. The current cohort delineates the dynamic nature of hypospadias in itself. We speculate that the distinction in the primary complaint leading to referral between the extremes of age may relate to the vanity and insecurity of youth while older patients first come forward when other symptoms arise. Dissatisfaction with genital appearance is uncommon in previous smaller studies on men with uncorrected hypospadias unlike in our study, where 11 patients were assessed mainly for cosmetic concerns. Obstruction is the main symptom encountered in adult hypospadias patients operated in early life, and a similar picture was observed in our cohort of unoperated cases. Urethral dilatation and internal urethrotomy are temporizing procedures but were successful in immediate alleviation of obstructive symptoms in patients not willing to consign themselves to formal surgery. The study is limited by its retrospective design, and our symptomatic cohort may also represent the extreme end of the hypospadias spectrum. Medical issues vary across the age span in men with unrepaired hypospadias. Minor surgical procedures as well as counselling play an equally important role as reconstructive hypospadias surgery in the management of unrepaired hypospadias in adulthood.

Diagnosis and treatment of urethral stricture in men with neurogenic lower urinary tract dysfunction:A systematic review.

To summarize available data focused on diagnosis and management of urethral stricture in men with neurogenic lower urinary tract dysfunction by a systematic review of the literature. A systematic review of the literature was carried out through an extensive electronic database search performed in PubMed/MEDLINE and Scopus databases for full texts, and International Continence Society, American Urology Association, and European Association of Urology abstracts for citations related to urethral structure. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A total of 316 articles were identified, 48 of which were selected for this review. Different strategies are currently being used for the management of urethral strictures, such as clean intermittent catheterization (CIC)which reduces stricture by up to 68%; direct vision internal urethrotomy which shows lower rates of renarrowing; urethroplasty which shows a success rate up to 70%; urinary diversion is the treatment of choice when reconstruction is not possible. Further studies are needed in this population because of the heterogeneity of the outcomes and the lack of a standardized definition and classification of this population.

The success of dorsal onlay buccal mucosal graft urethroplasty in challenging urethral stricture cases after multiple failed urethrotomies.

Urethroplasty is the gold standard treatment procedure for male patients with urethral stricture and is becoming increasingly popular among urologists worldwide. Procedure success rates have risen with increased experience. Here we aimed to examine the results of urethroplasty in challenging cases of urethral stricture and its effect on sexual function. Data were collected retrospectively from the patients who had undergone urethroplasty after multiple failed direct vision internal urethrotomy (DVIUs) from 2017 to 2020. All patients were monitored for a minimum of 12 months. Outcomes of urethroplasty were analyzed according to stricture location, length, and the number of prior DVIUs. Penile length and sensation, erectile, and ejaculatory function of the patients were evaluated pre- and postoperatively. The patient cohort consisted of 36 males with a mean age of 63 ± 3.2 years. The most prevalent stricture etiology was iatrogenic (83%). Patients who underwent three or more DVIUs before urethroplasty and stricture length >4 cm were included in the analysis. Accordingly, the overall success rate was 83% (30/36). When the success rate and the IIEF5 scores were assessed separately, there was no significant relationship between the number of DVIUs (P > 0.05). Similarly, no significant relationship was also found with the stricture length (P > 0.05). Appropriate and correctly applied surgical technique does not impair sexual activity, even in patients with severe urethral stricture, regardless of the length or location of the stricture and the number of prior endoscopic procedures.

PD28-11 VALUE OF ROUTINE PRE-OPERATIVE CYSTOSCOPY PRIOR TO INSERTION OF PENILE PROSTHESIS

You have accessJournal of UrologyCME1 May 2022PD28-11 VALUE OF ROUTINE PRE-OPERATIVE CYSTOSCOPY PRIOR TO INSERTION OF PENILE PROSTHESIS Leonid Aksenov, Zachary Dionise, Faysal Yafi, and Aaron Lentz Leonid AksenovLeonid Aksenov More articles by this author , Zachary DioniseZachary Dionise More articles by this author , Faysal YafiFaysal Yafi More articles by this author , and Aaron LentzAaron Lentz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002576.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile prosthetic implants have been used for almost 50 years for refractory erectile dysfunction, with approximately 20,000 annual implants in the United States alone. Historically, some urologists have advocated for routine pre-operative cystoscopy to evaluate for the presence of lower urinary tract obstruction prior to prosthesis placement. The rationale being that the treatment of lower urinary obstruction should supersede prosthetic placement and management of these conditions may be complicated with a prosthetic in place. Anecdotally, the risk of such significant asymptomatic urethral pathology is quite low. Cystoscopy, in addition to carrying the risk of peri-procedural infection, does have a substantial associated cost. Thus, our objective was to retrospectively evaluate the prevalence and cost of incidentally discovered urethral pathology during inflatable penile prosthesis (IPP) placement. METHODS: We retrospectively identified all inflatable IPP insertions (CPT 54405 or 54410) performed or aborted by a single surgeon (ACL) from 1/1/14 to 9/15/21. Of those, we then identified and reviewed patients who underwent intraoperative urethral dilation (CPT 52281), direct vision internal urethrotomy (CPT 55276), or cystoscopy (CPT 52000). Costs were calculated based on our institution’s cost data. Total and average cost of routine office cystoscopy for each IPP was compared to total cost of aborted IPPs. RESULTS: A total of 726 inflatable IPP placement cases were identified. An intraoperative cystoscopy was performed in 13 (1.8%) cases. Of those, 5 (0.7%) cystoscopies were planned and 8 (1.1%) were unplanned. Of the IPP cases with unplanned cystoscopies, 4 cases were aborted (0.5%); 3 cases were aborted due to a urethral stricture and 1 case was aborted due to a urethral perforation following corporal dilation. Unplanned intraoperative cystoscopies and interventions had an average supply cost of $216, totaling $1,732. The total supply cost of aborted IPPs due to urethral stricture was $4,182, an average of $1,394 per case. If every IPP case underwent a pre-operative cystoscopy, the estimated total cost would have been $234,498 ($323 per case). CONCLUSIONS: Given the rarity of incidental urethral strictures requiring aborted IPP and intervention, the cost of routine pre-operative cystoscopy far exceeded the cost of aborted IPP procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e502 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonid Aksenov More articles by this author Zachary Dionise More articles by this author Faysal Yafi More articles by this author Aaron Lentz More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP20-19 EARLY ENDOSCOPIC REALIGNMENT OF POST TRAUMATIC URETHRAL DISRUPTION

You have accessJournal of UrologyCME1 May 2022MP20-19 EARLY ENDOSCOPIC REALIGNMENT OF POST TRAUMATIC URETHRAL DISRUPTION Camille Haudebert, Juliette Hascoet, Vivien Graffeille, Karim Bensalah, Gregory Verhoest, Zine Eddine Khene, Romain Mathieu, Andrea Manunta, Benoit Peyronnet, and Lucas Freton Camille HaudebertCamille Haudebert More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Vivien GraffeilleVivien Graffeille More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Gregory VerhoestGregory Verhoest More articles by this author , Zine Eddine KheneZine Eddine Khene More articles by this author , Romain MathieuRomain Mathieu More articles by this author , Andrea ManuntaAndrea Manunta More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , and Lucas FretonLucas Freton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002553.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic Fracture Urethral Injury (PFUI) is a rare but challenging to treat. The initial optimal management is not defined. The objective of the present study was to access short and long term results of early endoscopic realignment (EER) performed for male urethral disruption in a French university hospital. METHODS: All men who underwent an early endoscopic realignment for a PFUI between decembre 2004 and may 2019 in our center were included. Preoperative and perioperative outcome data were collected. The rate of complications for the surgical procedure was analyzed, as well as the rate of post-operative stenosis, erectile dysfunction and incontinence. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow up. RESULTS: Twenty-four patients were included : 17 posterior urethral disruption and 7 anterior. The median time to realignment was 9 days (4-19). There were 3 realignment failure. The median operative time was 30 minutes (10-150). 18 of 21 patients resumed micturition after the surgery, one patient had an early post-operative urethral stricture, and two patients had perineal abscesses and were referred to an outside center for urethroplasty. Initial success rate of the procedure was 29.2% (7/24). Mean follow up time was 36 months (4-190).Eleven of 18 patients developed a urethral stricture during follow up. Seven patients were treated by one or two direct visual internal urethrotomy. Finally, only 8/24 patients (33,33%) required urethroplasty. There were no urethroplasty failure after previous EER. One patient reported stress urinary incontinence after two urethroplasty. There were insufficient data to conclude about erectile dysfunction. CONCLUSIONS: Early endoscopic realignment for PFUI has a low initial success rate but a majority of patients can benefit from endoscopic treatment afterwards and it did not compromise later urethroplasty. Thus, it seems licit to propose EER as first treatment for PFUI. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e325 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Camille Haudebert More articles by this author Juliette Hascoet More articles by this author Vivien Graffeille More articles by this author Karim Bensalah More articles by this author Gregory Verhoest More articles by this author Zine Eddine Khene More articles by this author Romain Mathieu More articles by this author Andrea Manunta More articles by this author Benoit Peyronnet More articles by this author Lucas Freton More articles by this author Expand All Advertisement PDF DownloadLoading ...

V07-09 ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY AND URETHRAL PULL THROUGH OF MEMBRANOUS URETHRA TO BLADDER

You have accessJournal of UrologyCME1 May 2022V07-09 ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY AND URETHRAL PULL THROUGH OF MEMBRANOUS URETHRA TO BLADDER Safiya-Hana Belbina, Scott Spivey-Provencio, Pegah Taheri, E. Charles Osterberg, and Aaron A. Laviana Safiya-Hana BelbinaSafiya-Hana Belbina More articles by this author , Scott Spivey-ProvencioScott Spivey-Provencio More articles by this author , Pegah TaheriPegah Taheri More articles by this author , E. Charles OsterbergE. Charles Osterberg More articles by this author , and Aaron A. LavianaAaron A. Laviana More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002598.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While robotic assisted laparoscopic prostatectomy has been a durable treatment option for men with localized prostate cancer over the past two decades, salvage prostatectomies are performed less frequently. In this video, we report a unique case of a salvage prostatectomy and membraneous urethra pull-through in an individual who was treated with both high-intensity focused ultrasound and external beam radiation therapy complicated by prostate cancer recurrence and a severe bulbar urethral stricture that failed direct visual internal urethrotomy. METHODS: The case presents a 71-year-old male with a urological history of prostate cancer in 2010 treated with HIFU. Following biochemical recurrence in 2013 he subsequently underwent salvage EBRT. This was complicated by a severe bulbar urethral stricture necessitating two DVIUs In addition, the patient underwent transurethral resection of the prostate for obstructed voiding symptoms and placement of an inflatable penile prosthesis. From a cancer standpoint, his PSA slowly rose after EBRT from 1.3 in 2019 to 2.7 in 2021. Repeat prostate biopsy showed 1/14 cores positive for Gleason Score 4+4=8 prostate cancer. The patient proceed with a robotic-assisted laparoscopic prostatectomy with a urethral pull through and bilateral pelvic lymph node dissection. The video begins with dissection of the prostatic apex to entirely free up and remove the prostate. Once the prostate is separated from the urethra, the dissection continues until the old bulbar urethral scar is completely removed. After we ensure the remnant urethra is free of scar and patent, the urethra is seen being passed through from below into the pelvic cavity and the anastomosis is performed. We then proceeded with a bilateral pelvic lymphadenectomy using the synchroseal device which obviates the need for any clips. The patient’s inflatable prosthesis reservoir makes the right side more challenging, however, it is feasible with careful dissection. RESULTS: The patient was discharged on post-operative day 1 with all drains removed and his post-operative course remained uncomplicated. On post-operative day 19, he had a normal voiding cystourethrogram. CONCLUSIONS: This case discusses the surgical technique used in a salvage robotic-assisted prostatectomy with membranous urethral pull-through in a patient with previous history of HIFU, salvage EBRT, bulbar urethral stricture, and inflatable penile prosthesis. In this video, we show this is a feasible option in select men and may spare them the burden from undergoing a radical cystoprostatectomy. Source of Funding: n/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e661 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Safiya-Hana Belbina More articles by this author Scott Spivey-Provencio More articles by this author Pegah Taheri More articles by this author E. Charles Osterberg More articles by this author Aaron A. Laviana More articles by this author Expand All Advertisement PDF downloadLoading ...

Prevalent Practices in Male Anterior Urethral Stricture Management: A Survey

Objective: This article aimed to study the prevalent practices in the treatment and follow-up of urethral strictures. Moreover, the article aimed to investigate the present opinion among urologists as the treatment practices for urethral stricture disease are mostly dependent on the treating surgeon’s expertise and preference in the absence of widely followed standard guidelines. Methods: A questionnaire was formulated based on the responses from experts. From October to December 2020, all members of the urological society of India received a mailed questionnaire on a web-based survey platform. Practicing urologists from across the country are among its members. Results: A total of 2554 urologists were contacted by mail, and 282 (11%) urologists provided a response. The majority were doing 5 to 15 urethroplasties a year. A newly diagnosed short segment bulbar urethral stricture would be a candidate for a visualized internal urethrotomy (VIU), according to 69.5% of urologists. Recurrence after one attempt at VIU prompted 80% to switch to urethroplasty as the next choice. During preoperative evaluation, 100% of respondents wanted a retrograde urethrogram, 74% deemed micturating cystourethrogram necessary, and 60% wanted a urethroscopy. At discharge, the majority preferred silicone Foley catheters, and the preferred size was 16F (54%). The patients were discharged with both suprapubic catheter and Foley in situ by most urologists. During follow-up, 60.99% wanted uroflowmetry, and the duration of follow-up varied. Conclusion: This survey on urethral stricture management amongst urologists shows that there is wide variation in the management of stricture urethra. This survey underscores the need for large-scale, long-term studies to formulate a guideline for the management of urethral stricture disease, thereby bringing uniformity in the care provided.

Effects of Combination of Bi-inject (Triamcinolone and Mitomycin) After Direct Vision Internal Urethrotomy for Short Urethral Strictures

Background: Urethral stricture disease has always been a challenge for urologists. Different treatment modalities that are used for treatment of urethral stricture disease, however recurrence has been a persistent problem. Agents such as triamcinolone and mitomycin-C offer hope but merit to be researched.
 Objective: To test the combination of triamcinolone and mitomycin in direct vision internal urethrotomy (DVIU).
 Methods: This quasi-experimental analysis was conducted in Ziauddin Hospital North Nazimabad upon a sample of 116 patients (selected using non-probability, consecutive sampling) in two groups (A: Experimental and B: Control) of 58 each. Data was recorded onto a structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, disease history, operative notes and post0operative follow-up. The data obtained was analyzed using SPSS 21.0 and MS. Excel 365.
 Results: The mean age of the sample stood at 47 (SD ± 05) years, with the age ranging from 19 to 80 years. The etiology was idiopathic in most (55.2%) of the cases and the primary urethral strictures were the commonest (67.2%). Most strictures appeared between 6 to 9 months after the procedure and the incidence decreased with passage of time till no new cases were reported at 1 year. The outcome of the treatment in group A bi-inject given was regarded as success in 49 (84.5%) and in group B bi-inject not given was 32 (55.2%) of the cases. Among those that experienced a recurrence, majority (63%) of the patients experienced bulbar urethral stricture, while the remaining (37%) faced membranous urethral strictures. Few complications were seen in both groups, predominant among which was bleeding.
 Conclusion: After careful consideration, it is concluded administration of triamcinolone and mitomycin in direct vision internal urethrotomy (DVIU) yields a successful outcome significantly (<0.05) more frequently (84.5%) than the control group (52.5%).

Outcomes of ventral buccal mucosal graft urethroplasty: Our experience at tertiary care hospital.

Objective: To evaluate the outcomes of ventral buccal mucosal graft urethroplasty at tertiary care. Study Design: Case Control Study. Setting: Department of Urology, CMC/SMBBMU Larkana. Period: January 2018 to December 2018. Material & Methods: 50 patients with confidence interval of 95% and margin of error 5% Non-probability consecutive. All Data collected from record like age, stricture size, clinical presentation and routine investigation, Blood CP, ESR, urine culture and X-Ray retrograde urethrogram for proper diagnosis in all cases. Results: The mean age of patients was 35.2 years SD±15.25 years and Mean duration of symptoms was 14.7 month SD±9.98 month. Out of 50 cases of ventral onlay buccal mucosal graft urethroplasties, success rate was (90%). The main complication was transient swelling with altered sensation of lip in 3 cases (6%), 1 case (2%) with recurrent stricture at the site of proximal anastomosis, that was treated by direct vision internal urethrotomy. 1 case (2%) presented with impacted urethral stone that was removed endoscopically. Conclusion: Ventral buccal mucosa grafting urethroplasty give good results in long term with low rate of complications occurring mainly in first year postoperatively.

Outcome of Internal Optical Urethrotomy in Combination with Corticosteroids Injection in Recurrent Anterior Urethral Strictures

Background: Urethral stricture is a common urological disease and can occur mostly as a result of recurrent infections, inflammation, trauma or unknown factors. Internal optical urethrotomy is a useful treatment modality for the management of urethral strictures. Several adjuvant interventions are suggested to decrease the recurrence rate of urethral strictures. Objectives: To report the success rate of internal optical urethrotomy in combination with corticosteroids in recurrent anterior urethral strictures. Materials and Methods: This prospective clinical randomized control trial was performed on 70 patients from 1st January 2017 to 31st Dec 2018. Patients fulfilling the inclusion criterion were randomly divided into two groups. The experimental group comprises 34 patients who received a corticosteroid injection in combination with internal optical urethrotomy while the control group consisting of 36 patients who received distilled water in combination with internal optical urethrotomy. All the patients were advised not to do clean intermittent self-catheterization (CISC) and were followed for 24 months. Results: The mean follow-up time was 9 ± 5.40 months (6-24 months). Complications occurred in 14 patients. In the experimental group recurrence of stricture occurred in 11 patients, extravasation into perispongeal space in 3 patients (8.82%), infection in 1(2.94%) and bleeding in 2(5.8%) patients. In the control group recurrence of stricture occurred in 16 patients, Infection occurred in 3 patients and extravasation and bleedings in 2 and 3 patients respectively. Moreover, the difference between the recurrence in the experimental and control groups is also not significant (p.0.05). However, the stricture-free duration that is the time of recurrence was significantly delayed in the experimental group (8.07 ± 5.51 versus 3.8 ± 1.53 months). Conclusion: It is concluded that internal optical urethrotomy in combination with corticosteroid injection delays the recurrence rate of urethral stricture significantly. It can also be a feasible procedure for those who do not want urethroplasty or those with high risk for general anesthesia.

Unravelling the Role of Internal Optical Urethrotomy in Male Urethral Stricture Management

Background and aim: Male urethral stricture is still regarded as one of the most common and perplexing urological problems. Dilation, endoscopic urethrotomy, and urethroplasty are all options for treatment, however internal optical urethrotomy has a faster recovery time, less scarring, and a decreased risk of infection. The purpose of this study was to see how effective internal optical urethrotomy was in treating patients with urethral stricture. Materials and Methods: Between August 2020 and May 2021, the author at National institute of urology and nephrology, Cairo, Egypt, conducted this research. Internal ocular urethrotomy was used to treat a group of 18 male patients aged 22 to 51 who had urethral strictures. The follow-up time was between one and two months. The outcome was given a good, fair, or bad rating. Results: 44.44 % of the 18 patients were between the ages of 45 and 51. Trauma was the most common cause of stricture in 8 (44.4%) of patients, and poor urination was the most common presenting symptom in 6 (33.3%). The bulbous urethra was found to be the most common region of restriction in 9 (50%), followed by the penile urethra in 6 (33.3%) cases. The overall response rate was good in 12 individuals (66.7%). Only urethral hemorrhage was observed in 2 (11.1%) of the patients after surgery, with no additional significant problems. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.

Unravelling the Role of Internal Optical Urethrotomy in Male Urethral Stricture Management

Background and aim: Male urethral stricture is still regarded as one of the most common and perplexing urological problems. Dilation, endoscopic urethrotomy, and urethroplasty are all options for treatment, however internal optical urethrotomy has a faster recovery time, less scarring, and a decreased risk of infection. The purpose of this study was to see how effective internal optical urethrotomy was in treating patients with urethral stricture. Materials and Methods: Between August 2020 and May 2021, the author at National institute of urology and nephrology, Cairo, Egypt, conducted this research. Internal ocular urethrotomy was used to treat a group of 18 male patients aged 22 to 51 who had urethral strictures. The follow-up time was between one and two months. The outcome was given a good, fair, or bad rating. Results: 44.44 % of the 18 patients were between the ages of 45 and 51. Trauma was the most common cause of stricture in 8 (44.4%) of patients, and poor urination was the most common presenting symptom in 6 (33.3%). The bulbous urethra was found to be the most common region of restriction in 9 (50%), followed by the penile urethra in 6 (33.3%) cases. The overall response rate was good in 12 individuals (66.7%). Only urethral hemorrhage was observed in 2 (11.1%) of the patients after surgery, with no additional significant problems. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.

Comprehensive analysis of paediatric pelvic fracture urethral injury: a reconstructive centre experience.

To analyse our experience in pelvic fracture urethral injury (PFUI) in children and adolescents, with various anastomotic urethroplasties (AUs) used to accomplish tension-free anastomosis described and their surgical outcomes evaluated. From 2008 to 2019, 192 cases including both primary and redo PFUI, which comprised 181 boys and 11 girls aged ≤18 years. The results are presented separately according to gender. Moreover, the two populations were divided in two age-related sub-groups for sensitivity analyses: Group 1 (children) aged ≤11 years and Group 2 (adolescent) aged 12-≤18 years. The median (interquartile range [IQR]) age at presentation in our series was 14 (9-17) years for boys and 9 (6-10) years for girls. Primary vs redo cases were 85 (47%) vs 96 (53%) in boys and 10/11 vs one of 11 in girls. In the primary male cases (85), the bulbo-membranous junction was the commonest site of injury (63, 74.1%). In boys, transperineal AU (TPAU) was performed in 160 (88.4%) and transpubic urethroplasty (TPU) in 17 (9.4%). In girls, TPU was utilised in nine cases, where two received meatoplasty and vaginal episiotomy. In boys, the overall success rate for TPAU was 81.2% and in primary PFUI cases success for TPAU was 88.3%. Overall success for TPU was 64.7%. In girls, the success rate for TPU was 100%. In boys and girls, the success rates for various AUs utilised between the child and adolescent groups were comparable. The median (IQR) hospital stay was 3 (3-4) days for boys and girls. The median (IQR) follow-up duration was 25 (16-33) months and 20 (17-27) months for boys and girls, respectively. Secondary procedures were performed in 39 boys and one girl, which comprised laser optical internal urethrotomy in 26 (14.4%) boys and redo surgery in 13 (7.2%) boys and one (9.1%) girl. Of all patients, four of the 11 girls and 74 boys (38.5%) were lost to follow-up. Most paediatric PFUI can be addressed via a transperineal approach with reasonable long-term outcomes. In challenging cases salvage procedures utilising vascular-based flaps as a urethral substitute give satisfactory results. Even young children can be managed with a high success rate in expert hands and these injuries should be addressed by specialist reconstructive urologists.

Outcomes of Vesicourethral Anastomotic Stenosis and Bladder Neck Contracture With Direct Visual Internal Urethrotomy With Mitomycin-C After Prostate Cancer Treatment

ObjectiveTo examine the use of Direct Visual Internal Urethrotomy with Mitomycin-C (DVIU-MMC) for bladder neck contracture and vesicourethral anastomotic stenosis in men who have undergone treatment for prostate cancer with radical prostatectomy and/or radiation therapy. MethodsRetrospective chart review of patients at a tertiary care center who underwent DVIU-MMC for recurrent bladder neck contracture/vesicourethral anastomotic stenosis between 2012 and 2020. Patients with complete urethral obliteration, prior bladder neck reconstruction, or less than 3 months of follow-up were excluded. Patients were sorted into three groups based on prostate cancer treatment history: radical prostatectomy (RP), RP with subsequent external beam radiation therapy (RP-EBRT), and radiation therapy (RT). ResultsFifty-one patients with a median follow up of 32 months were included. Twenty-nine percent had pre-operative suprapubic tube (SPT), Foley, or required clean intermittent catheterization. Overall success after initial DVIU-MMC was 45%. In all patients with up to four procedures, cumulative overall success was 84%. There was no significant difference in relative success rates between groups. However, the interval to recurrence after initial DVIU-MMC was shortest for RP-EBRT group (P = .018). Three patients required SPT, all were in the RP-EBRT group. There was no statistical difference in recurrence after any number of procedures between patients in radiation (RP-EBRT and RT) and non-radiation (RP) groups. ConclusionThere was no significant difference in success rates between patients who had undergone RP-EBRT, RT, or RP. However, our data suggests that RP-EBRT patients experience poorer outcomes given that their interval to recurrence was more rapid and all patients requiring SPT placement were in this group.

A0857 - Efficacy of topical triamcinolone for intermittent catheterization following internal urethrotomy: A systematic review and meta-analysis of randomized controlled trials

A0857 - Efficacy of topical triamcinolone for intermittent catheterization following internal urethrotomy: A systematic review and meta-analysis of randomized controlled trials

PREDICTORS FOR FAILURE OF DIRECT VISION INTERNAL URETHROTOMY (DVIU) FOR SINGLE AND SHORT BULBAR URETHRAL STRICTURES? A FACT OR FALLACY

Aims & Objectives: To identify patient and stricture characteristics predicting failure after direct vision internal urethrotomy (DVIU) for single and short (<2 cm) bulbar urethral strictures. Materials & methods: We retrospectively analysed 1260 adult patients who underwent DVIU between September 2007 to January 2021 in the Department of Urology,Institute of Nephrourology(INU),Bangalore. The patients' demographics and stricture characteristics were analysed. The primary outcome was procedure failure, dened as the need for regular self-dilatation (RSD), redo DVIU or substitution urethroplasty. Predictors of failure were analysed. For association between categorical variables, the chi-square test was used, while the Student's t-test was used for comparing means between groups. Logistic regression analysis was used to determine independent predictors of failure after DVIU. All statistical analysis was performed using SPSS statistical software, with a P< 0.05 considered to indicate statistical signicance. Results & Observations:In all,1260 adult patients with a mean (SD) age of 48.3 years were included. The main causes of stricture were idiopathic followed by iatrogenic in 48.3% and 29.4 % of patients, respectively. Most patients presented with obstructive lower urinary tract symptoms (64.5%) and strictures were proximal bulbar, i.e. just close to the external urethral sphincter, in 38.3%. The median (range) follow-up duration was 24 (8-127) months. In 60.1% patients did not require any further instrumentation, while RSD was maintained in 28.3%,patients. On multivariate analysis, older age at presentation [odds ratio (OR) 1.014; P = 0.02], obesity (OR 1.624; P = 0.013), and idiopathic strictures (OR 3.102; P = 0.035) were independent predictors of failure after DVIU. Conclusions:The failure rate after DVIU accounted for 39.9 % of our present study with older age at presentation, obesity, and idiopathic strictures independent predictors of failure after DVIU. This information is important in counselling patients before surgery.

The Efficacy and Safety of a Conservative Management Approach to Radiation-Induced Male Urethral Strictures in Elderly Patients With Comorbidities

Objectives To assess the outcomes of a conservative management approach to radiation-induced urethral stricture disease (R-USD) in an elderly population with comorbidities. Methods Patients with R-USD managed with endoscopic procedures and/or clean intermittent catheterization (CIC) between 2007 and 2019 were included. Patients were excluded if they had an obliterative stricture, prior urethral reconstruction/urinary diversion surgery, or < 3 months follow-up. Primary outcome measures were urinary tract infection (UTI), acute urinary retention (AUR), serum creatinine, uroflowmetry/post-void residual, and urinary incontinence (UI). Failure was defined as progression to reconstructive surgery or permanent indwelling catheterization. Results Ninety-one men were analyzed with a median follow-up of 15.0 months (IQR 8.9 to 37.9). Median age was 75.4 years (IQR 70.0 to 80.0), body mass index was 26.5 kg/m2 (IQR 24.8 to 30.3), and Charlson comorbidity index was 6 (IQR 5 to 8). Median stricture length was 2.0 cm (IQR 2.0 to 3.0). Stricture location was bulbar (12%), bulbomembranous (75%), and prostatic (13%). A total of 90% underwent dilation, and 44% underwent direct visual internal urethrotomy (DVIU). For those that underwent these procedures, median number of dilations and DVIUs per patient was 2 (IQR 1 to 5) and 1 (IQR 1 to 3), respectively. Forty percent used CIC. Thirty-four percent developed a UTI, and 15% had an AUR episode requiring urgent treatment. Creatinine values, uroflowmetry measurements, and UI rates remained stable. Eighty percent avoided reconstructive surgery or indwelling catheterization. Conclusion Most elderly patients with comorbidities with R-USD appear to be effectively managed in the short-term with conservative strategies. Close observation is warranted because of the risk of UTIs and AUR. The potential long-term consequences of repetitive conservative interventions must be considered.

Are There Prognostic Factors for Failure of Surgical Treatment of Post-Traumatic Posterior Ureteral Stenosis? About 30 Cases and Review of the Literature

Introduction: The management of post-traumatic stenosis of the posterior urethra is divided between early endoscopic realignment and delayed surgery. In the latter case, several techniques are used taking into account several factors. Our objective was therefore to investigate the possible prognostic factors of failure of this surgical management. Material and Methods: We conducted a retrospective study from January 2006 to December 2017 on patients admitted to the Urology Department of the Mohammed 6 University Hospital of Marrakech for management of post-traumatic posterior urethral stenosis. The parameters studied were age, medical and surgical history, causes, characteristics of the stenosis (location, number, length), associated lesions, surgical technique used, and evolution. The descriptive analysis consisted of calculation of absolute and relative frequencies for the qualitative variables, and of position and dispersion parameters for the quantitative variables (mean, standard deviation). In bivariate analysis, the comparison of categorical variables used Pearson’s Chi-square statistical test and Fisher’s test if necessary. The significance threshold was set at p < 0.05. Results: A total of 30 cases were selected. The age of our patients varied between 18 and 68 years, with an average of 38.33 years (16 - 80 years); the most affected age group was between 20 and 39 years. The mode of revelation of urethral damage was dominated by acute retention of urine present in 76% of patients, followed by dysuria (33%). The stenosis extended over 21.91 mm on average (14 - 40 mm). It was accompanied by bone involvement in 15 patients (53.3%). Erectile dysfunction was present in 23 patients (23%). Terminal urethrogram was the main surgical technique used, followed by internal urethrotomy (60% and 30% respectively). 15 patients had a recurrence, with an average of 1-second operation. Statistical analysis of the different factors studied showed no correlation with the occurrence of recurrence after surgical treatment. Conclusion: The medium and long term results of anastomotic repair of the posterior urethra do not seem to depend on the lesion parameters of the stenosis (site, number, extent, presence of associated bony lesions or erectile disorders).