Management Of Anterior Urethral Strictures Research Articles

Management of Anterior Urethral Stricture: A Survey of Contemporary Practice of Iranian Urologists.

To evaluate Iranian urologists' approach to urethral stricture and assess how often they select open urethroplasty over minimally invasive procedures. This cross-sectional observational study was conducted via www. porsline.ir among members of the Iranian urologists' community. The urologists were contacted via email and social media applications (e.g., WhatsApp, Telegram), and data, including their demographic information and years of practice, as well as questions related to their attitude towards the management of urethral stricture, were collected. A total number of 376 patients were included in the current survey. The specialty of reconstructive urology was selected by less than 2% (n=5) as their field of interest. Only 6.64% (n=25) of the urologists stated that they received adequate training for management of urethral stricture. Only about 5% (n=19), believed that according to scientific resources, chose open urethroplasty as the initial management. Almost 94% (n=353) did not perform any urethroplasties during the past year and about 0.2% (n=2) performed more than 20 open urethroplasties. For diagnosing urethral stricture, almost 99% of them chose RUG+VCUG, 72% chose urethrocystoscopy, and 69% chose uroflowmetry in the third place. For evaluation of urethroplasty postoperative outcomes, 76% (n=269) used RUG+VCUG, 15% (n=56) used Rigid Cystoscopy, and 8% (n=29) used Flexible Cystoscopy, Conclusion: Iranian urologists prefer minimally invasive procedures for treating urethral stricture, similar to other countries. This lack of urologists' interest in open urethroplasty is greatly due to poor training during the residency years and little experience with urethral strictures. Therefore, further considerations in order to improve urologists' knowledge and expertise for management of urethral stricture is recommended.

Evaluation and management of urethral strictures-guideline summary 2024 : part1-anterior urethra

In recent years, several international urological societies have published guidelines on the diagnosis, treatment, and follow-up of urethral strictures, but aguideline for the German-speaking region has not been available to date. This summary provides adetailed comparison of the guidelines of the European Association of Urology (EAU), American Urological Association (AUA) and the Société Internationale d'Urologie (SIU) with regard to the treatment of anterior urethral strictures, i.e. from the bulbar urethra to the meatus. In the following work, differences and specific recommendations in the guidelines are highlighted. In particular, the three guidelines largely agree with regard to diagnostic workup and follow-up. However, divergences exist in the management of anterior urethral strictures, particularly with regard to the use of endoscopic therapeutic approaches and the use of urethral stents. In addition, the EAU provides more comprehensive and detailed recommendations on urethroplasty techniques and specific patient follow-up. The EAU guidelines are the most current and were the first to include instructions for urethral strictures in women and individuals with gender incongruence after genital approximation surgery. Reconstructive urology is arapidly evolving specialty and, thus, the clinical approach has been changing accordingly. Although guideline recommendations have become more inclusive and comprehensive, more high-quality data are needed to further improve the level of evidence.

Outcomes of Anterior Urethral Stricture Management in a Tertiary Care Hospital in Eastern Nepal

Introduction: The standard guidelines for the management of anterior urethral strictures categorizes as transurethral procedures like dilatation and urethrotomy; and open surgical procedures like urethroplasty. This study aims to find the extent and outcome of anterior urethral strictures managed in a tertiary care hospital in eastern Nepal. Methods: It was a hospital-based cross-sectional study. Patients were evaluated preoperatively as per institutional protocol. The procedure was done either in local or spinal or general anesthesia with nasal intubation. At the end of the procedure, a 14 Fr Silicon catheter was inserted per urethra and removed either on the next day, 2 weeks or 4 weeks post operatively depending upon the type of procedure done. Patients were asked to follow up postoperatively at 6 weeks and three months. Results: Thirty-six cases were eligible. The mean age of the patients was 39.25±14.02 years. According to the etiology; 36.1% were iatrogenic, 30.6% traumatic, 25% were balanitis xerotica obliterans or genital lichen sclerosus (BXO/LS) associated and 8.3% were infective respectively. Similarly, 61.1% of strictures were bulbar in location, 22.2% panurethral, 11.1% penile and 5.6% meatal. The mean length of the stricture was 4.26± 4.22 cm (range 1-14 cm). Similarly, Visual internal urethrotomy (VIU) was done in 47.2%, augmentation urethroplasty in 44.4% meatoplasty in 5.6% and anastomotic urethroplasty in 2.8% respectively. Complications occurred in 11.1% of cases. Conclusion: Visual internal urethrotomy was the commonly performed procedure for the urethral stricture. Meatal stenosis was the most common complication

Updates in substitution urethroplasty for anterior male urethral strictures

Substitution urethroplasty is an essential tool in the armamentarium of management of anterior urethral strictures, due to the limitations of anastomotic urethroplasty for penile urethral strictures and bulbar strictures beyond 2 cm in length. Various urethroplasty techniques with different grafts or flaps have been described. In this review article, the rationale of utilisation of different substitution urethroplasty techniques are described. Evaluation of urethroplasty outcomes should include not only voiding function and sexual outcomes, but also patient-reported outcome measures (PROMs) and overall satisfaction.

Comparison between Lingual Mucosal Graft Urethroplasty and Buccal Mucosal Graft Urethroplasty in The Management of Anterior Urethral Stricture.

Background: Urethral stricture is a chronic and common urological problem in Bangladesh and its management poses a big challenge to urologists. Surgical treatment of urethral stricture diseases is a continuously evolving process, and the superiority of one technique over another has yet to be clearly demonstrated. Urethrotomy is the most commonly used technique but long term results are not satisfactory. Long penile urethral strictures are best treated by substitution urethroplasty. The ideal graft material for substitution urethroplasty is constantly evolving. Buccal mucosa produces excellent result but is associated with many long term donor site complications. Lingual mucosa is an alternative donor site for graft urethroplasty and achieved good functional and aesthetic results. Materials & Methods: A hospital based prospective study was conducted in the department of urology, Dhaka Medical College Hospital from July 2016 to March 2017. Total 40 patients were included in this study. They were divided in two groups, group 1 was treated by lingual mucosal graft and group 2 was treated by buccal mucosal graft. All patients were followed up for six months noting pre and post-operative maximum urine flow rate (Qmax), voiding time and complications at both urethroplasty and donor site. Results: There were no significant differences in overall operative success rate between two groups of patients. But complications at donor site were higher in group 2 patients. Conclusion: Lingual mucosal graft urethroplasty may be preferred to buccal mucosa in anterior urethral stricture as it is easy to harvest and is associated with less short and long term donor site complications without significant difference in operative success rate. KYAMC Journal Vol. 13, No. 02, July 2022: 108-114

Comparative review of the guidelines for anterior urethral stricture.

We aimed to provide a detailed comparison between the American Urologic Association (AUA), Société Internationale d'Urologie (SIU), and the European Association of Urology (EAU) guidelines on the evaluation, management, and follow-up of the patients with anterior urethral stricture disease (USD). The urethral stricture guidelines from SUI, AUA, and EAU were collected and evaluated regarding the recommendations on diagnosis, evaluation, and treatment of anterior USD. The strength of evidence for each statement was included and discussed when guidelines differed. While the guidelines remarkably align in terms of the diagnostic workup and follow-up, there is discordance in the management of anterior urethral strictures, specifically for the use of endoscopic treatment and stenting. Further, the EAU offers more comprehensive recommendations regarding urethroplasty techniques and patient follow-up. The EAU guidelines are the most recent and first to offer guidance for USD in transgender people and women. Reconstructive urology is a rapidly adapting field, and best practices change accordingly. Guideline statements have become more inclusive and expansive but will require further research to improve the level of evidence and continue to provide patients and providers with the best treatment plans.

This Month in Adult Urology

This Month in Adult Urology

Results of Buccal Mucosal Graft Urethroplasty in Management of Anterior Urethral Stricture – Experience in a Single Center

Objective: To share our experience with buccal mucosal graft (BMG) urethroplasty for the management of anterior urethral strictures in BIRDEM General Hospital, Dhaka. Materials and methods: This study was conducted from January 2013 to January 2018. Patients selected according to inclusion and exclusion criteria. The oral mucosal characteristics were assessed in all patients during the initial workup. Single stage dorsolateral onlay graft urethroplasty done in all patients. They were followed according schedule for outcome and complications. Result:Total 59 patients were studied. Overall success rate of BMG urethroplasty was 88.1% at 12th month. Complications include development of periurethral abscess (3.4%), restructure (8.5%) development of fistula (1.7%). Total 8 patients underwent retreatment procedures like drainage of periurethral abscess, dilatation, optical internal urethrotomy (OIU) and revision urethroplasty. Conclusion:The buccal mucosa is easy to obtain and handle, therefore BMG urethroplasty is a safe and effective in managing anterior urethral stricture. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.128-131

Outcome of OMG Urethroplasty by Asopa, Barbagli and Kulkarni Technique for Management of Anterior Urethral Stricture : Are Results Affected by the Surgical Technique?

Objective: To determine outcome of OMG urethroplasty by different surgical technique comparing ASOPA, BARBAGLI and KULKARNI TECHNIQUE in the management of anterior urethral stricture. Materials and Methods: A total of 62 patients with an average age of 42 yr(21-55) underwent OMG urethroplasty between 2008 to 2015 for anterior urethral stricture of different etiology. 2 patient lost durig follow up patient with lichen sclerosus and failed hypospadias were not included. OMG was always harvested from cheek using 2 team approach graft were placed using surgical technique of ASOPA, BARBAGLI and KULKARNI technique in 21,27 and 12 patients respectively clinical outcome was considered success or failure at the time any post operative procedure needed mean follow up was 45 month (6-95) Results: Out of 60 cases 51(85%) considered success and 9(15%) were considered failure. success rate were 85.7%,85%,and 83.5% in ASOPA, BARBAGLI and KULKARNI Technique and failure rate were 14.3%,15% and 16.7% respectively. Failure involve in the anastomotic site (2 in distal and 3 in proximal) were managed by OIU and involving whole length in 3 patient managed with staged urethropllasty. Conclusion: In our series, success rate of ASOPA, BARBAGLI and KULKARNI technique has no statistically significant variation. more over stricture recurrence was uniformly distributed in all group. so the outcome is not significantly affected by different technique used in OMG urethroplasty for anterior urethral stricture. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.23-27

Outcomes of urethroplasty for anterior urethral strictures: A single-center experience

Purpose: The management of anterior urethral strictures is quite challenging due to high failure rates with many unavoidable postoperative complications. This study aims to elucidate the appropriate surgical techniques, advantages, and disadvantages of the different urethroplasties. Materials and Methods: We retrospectively recorded and analyzed twenty patients' demographics, surgical techniques, postoperative uroflowmetry, and complications. Patients were divided into two groups depending on the length of their strictures. Patients in Group 1 presented a urethral stricture or obliteration length of

Endoscopic management of anterior urethral strictures by use of direct visual internal urethrotomy with mitomycinC and clean intermittent catheterization

Endoscopic management of anterior urethral strictures by use of direct visual internal urethrotomy with mitomycinC and clean intermittent catheterization

Algorithm for the management of anterior urethral strictures.

Anterior urethral strictures include penile, bulbar and panurethral strictures. In the literature various techniques have been mentioned for their management from single stage to two-stage approach. There are no guidelines concerning the use of dorsal or ventral approaches in bulbar urethroplasty. We share our simplified algorithm for the management of anterior urethral strictures. This algorithm is based on the last three decades of experience in urethroplasty and surgeries all around the globe.

Anterior urethral strictures

AimThe aim of the present study was to determine the practice patterns in the management of anterior urethral strictures among urologists in Hong Kong.Patients and MethodsA 14‐item questionnaire was delivered either directly or by mail to all 126 registered urologists in Hong Kong. Information including demographic data, number of anterior urethral strictures treated, diagnostic methods, treatment options and follow‐up strategy were collected. The questionnaire also asked for the personal opinion about the treatment plan of two stricture case scenarios.ResultsThe response rate was 48 per cent. The majority (87 per cent) of urologists treated <10 anterior urethral strictures per year. Minimal invasive procedures, including urethral dilatation using metal sounds (77 per cent) or cystoscopy‐guided (74 per cent) and direct visual internal urethrotomy (57 per cent), were more commonly performed by urologists to treat urethral strictures. The majority of urologists (82.6 per cent) performed less than five urethroplasties per year.In the two case scenarios of long bulbous urethral stricture and recurrent short urethral stricture, approximately 10 per cent of respondents would refer the cases to other urologists and approximately 75 per cent would choose to perform reconstructive surgeries. The remaining 15 per cent of respondents would choose minimally‐invasive procedures for these strictures. Nearly two‐thirds (62.3 per cent) of urologists believed that urethroplasty should be proposed only after failed endoscopic treatment.Workups for urethral stricture disease were consistent, while the modalities to access the outcome were highly heterogeneous.ConclusionIn Hong Kong, the majority of urologists choose to perform urethroplasty for long bulbous urethral strictures and recurrent short bulbous urethral strictures in a case scenario situation. However, in actual practice, most perform less than five urethroplasties per year. A small caseload, lack of experience and understanding of urethral reconstructive surgery means that most urologists in Hong Kong would hesitate to carry out primary urethroplasty in correctly‐selected patients for whom primary reconstruction would have been the treatment of choice.

Management of Anterior Urethral Strictures in Adults: A Survey of Contemporary Practice in Germany

Introduction: Treatment methods of anterior urethral strictures in adults have undergone considerable changes in the recent past. Our goal was to determine national practice patterns among German urologists and to compare results with the results of prior international surveys. Methods: We conducted a survey on the management of urethral strictures among German urologists. Results: Eight hundred forty-five urologists, representing about 14.6% of German urologists, answered the survey. Most common procedures were direct vision internal urethrotomy (DVIU; 87.2%), blind internal urethrotomy (57.5%), dilatation (56.3%), ventral buccal mucosa graft urethroplasty (31.6%) and excision and primary anastomosis (28.9%). In case of a 3.5-cm bulbar stricture and in the case of a 1-cm bulbar stricture after 2 failed DVIUs, a consecutive urethroplasty was significantly more often favoured compared to transurethral treatment options (44.9 vs. 21.3% and 59.4 vs. 8.3%, both p < 0.001). Conclusion: Open urethral reconstruction reveals to be a more common method in practice nowadays. Adherence to recommended treatment algorithms improved in comparison to prior surveys.

New frontiers in urethral reconstruction: injectables and alternative grafts.

Contemporary management of anterior urethral strictures requires both endoscopic as well as complex substitution urethroplasty, depending on the nature of the urethral stricture. Recent clinical and experimental studies have explored the possibility of augmenting traditional endoscopic urethral stricture management with anti-fibrotic injectable medications. Additionally, although buccal mucosa remains the gold standard graft for substitution urethroplasty, alternative grafts are necessary for reconstructing particularly complex urethral strictures in which there is insufficient buccal mucosa or in cases where it may be contraindicated. This review summarizes the data of the most promising injectable adjuncts to endoscopic stricture management and explores the alternative grafts available for reconstructing the most challenging urethral strictures. Further research is needed to define which injectable medications and alternative grafts may be best suited for urethral reconstruction in the future.

Reconstruction for the distal urethral end incorrectly anastomosed to the proximal false passage in the treatment of urethral stricture.

Patient: Male, 24Final Diagnosis: Urethral strictureSymptoms: —Medication: —Clinical Procedure: —Specialty: UrologyObjective:Unusual or unexpected effect of treatmentBackground:The most dependable management of anterior urethral stricture is the complete excision of the area of fibrosis, with a primary reanastomosis of the normal ends of the anterior urethra.Case Report: A 24-year-old man had urethral stricture in the penoscrotal junction caused by catheterization approximately 3 years ago. After the resection of the urethral stricture segment and the end-to-end anastomosis were performed, in addition to stricture, urethrocutaneous fistula formation as another complication in the penoscrotal junction was confirmed. The direct vision internal urethrotomy did not improve all the above symptoms. The retrograde urethrogram and voiding cysto-urethrogram showed complete obliteration in the penile urethra, urethrocutaneous fistula, and proximal urethral bifurcation singularity. Intraoperatively, we found that the distal urethral end had been anastomosed to the proximal false passage in the initial surgery and the proximal urethra was located in the dorsal side of the false passage. Then, tubularized preputial flap urethroplasty was performed. The patient was followed up for 10 months. His peak urinary flow was 18.3 milliliter per second.Conclusions:We would remind urologists that urethral end intraoperatively anastomosed to the false passage is a rare, serious, avoidable, and elementary medical error. Urethroplasty is one of the curative choices for treatment of this unexpected condition.

Management of anterior urethral stricture

Background: The conventional method of repair of anterior urethral stricture with dilatation and Visual Internal Urethrotomy (VIU) resulted in high recurrence. Hence buccal mucosa is used for long term stricture free interval and is an effective measure of preventing stricture recurrence. Objectives: 1) To determine the presentation, aetiology, age distribution and associated symptoms of anterior urethral stricture. 2) To assess and compare the outcome of various modalities of management of anterior urethral stricture. 3) To find out the impact of buccal mucosal urethroplasty on long term symptom free interval and stricture recurrence. Materials and Methods: A prospective interventional study was carried out on 30 male patients, with anterior urethral stricture of varied aetiology, who were admitted in the Departments of Surgery and Urology, Kempegowda Institute of Medical Sciences and Research Centre, Bangalore, between June 2004 and June 2006. Procedure was carried for each patient depending on the site, nature and length of stricture. Results: The study showed that patients undergoing buccal mucosal urethroplasty had long term symptom free interval and no post operative complications nor recurrence during the study period. Conclusion: Though dilatation and VIU are used for palliative symptomatic relief in selected cases of anterior urethral stricture, buccal mucosal urethroplasty is the definitive treatment for anterior urethral stricture.

A Randomized Controlled Trial Comparing Combined Spongiosum Block and Intraurethral Lignocaine with Intraurethral Lignocaine Alone in Optical Internal Urethrotomy for Urethral Stricture

Optical internal urethrotomy is the most commonly performed procedure for the management of anterior urethral stricture. This study was performed to compare the safety and efficacy of spongiosum block along with intraurethral lignocaine with intraurethral lignocaine alone for optical internal urethrotomy. Fifty patients with anterior urethral stricture were prospectively randomized to undergo optical internal urethrotomy under spongiosum block along with intraurethral lignocaine (group 1=25 patients) and intraurethral lignocaine only (group 2=25 patients). The procedure-related pain was noted using the visual analogue scale. Postprocedure evaluation was performed by uroflowmetry and urethral calibration. Retrograde urethrography and micturating cystourethrography were performed as needed. Optical internal urethrotomy was successfully completed in all patients. The mean visual analogue score for pain in group 1 (1.5 ± 1.4) was significantly lower than the score in group 2 (2.7 ± 1.8) (P=0.006). At 6 months follow-up, recurrent strictures developed in three patients in group 1 and five patients in group 2. Spongiosum block with intraurethral lignocaine has a better anesthetic effect than intraurethral lignocaine alone for performing optical internal urethrotomy. Spongiosum block with intraurethral lignocaine is a viable alternative for regional and general anesthesia in the management of anterior urethral stricture with optical internal urethrotomy.

Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Prolonged Disease Duration

We examined the association of previous transurethral manipulation with stricture complexity and disease duration among men referred for bulbar urethral reconstruction. We retrospectively reviewed the records of 340 consecutive urethroplasties performed by a single surgeon between July 2007 and October 2010. Only men treated with initial open surgery for bulbar strictures were included in analysis, thus excluding those with hypospadias, lichen sclerosus, pelvic radiation, prior urethroplasty, incomplete data, or pure penile or posterior urethral stenosis. Cases were divided into 2 groups based on the history of transurethral treatment for urethral stricture before urethroplasty, including group 1-0 or 1 and group 2-2 or greater treatments. Of 101 patients with bulbar urethral stricture and all data available 50 and 51 underwent 0 to 1 and 2 or greater previous transurethral treatments, respectively. Repeat transurethral manipulation was strongly associated with longer strictures and the need for complex reconstruction. Repeat transurethral manipulation of bulbar urethral strictures was also associated with an eightfold increase in disease duration between stricture diagnosis and curative urethroplasty. Repeat transurethral manipulation of bulbar strictures is associated with increased stricture complexity and a marked delay to curative urethroplasty.

Management of adult anterior urethral stricture disease: nationwide survey among urologists in The Netherlands

Abstract Background Adult anterior urethral stricture disease is most often treated with dilatation or direct vision internal urethrotomy (DVIU). Although evidence suggests that anastomotic urethroplasty for short bulbar strictures is more efficient and cost effective in the long term, no consensus exists. It is unclear by whom and how often urethroplasties are performed in The Netherlands and how results are being evaluated. Objective To determine national practice patterns on management of anterior urethral strictures among Dutch urologists. This information will help to define the nationwide need for training in urethral surgery. Design, setting, and participants We conducted a 16-question survey among all 323 Dutch urologists. Results and limitations The response rate was 74%. DVIU was practised by 97% of urologists. Urethroplasty was performed at least once yearly by 23%, with 6% performing more than five urethroplasties annually. In the group of urologists younger than 50 yr of age, 13% performed urethroplasty, with 3% of those performing more than five annually. In the case of a 3.5-cm-long bulbar stricture, DVIU was preferred by 49% of responders. Even after two recurrences, 20% continued to manage a 1-cm-long bulbar stricture endoscopically. Of responders, 79% believed that urethroplasty should be proposed only after a failed endoscopic attempt. Diagnostic workup and evaluation of success varied greatly. Conclusions Most Dutch urologists believe that urethroplasty is an option only after failed DVIU. Endoscopic procedures are widely used, even when the risk of recurrence is virtually 100%. The definition of success is hampered by nonstandardised methods of follow-up. Only a small group of mainly older urologists frequently performs urethroplasties. Training programmes seem necessary to guarantee a high standard of care for stricture disease in The Netherlands. A pan-European practice survey might be interesting to clarify the need for centralised fellowship programmes.