One-stage Urethroplasty Research Articles

Staged urethroplasty with groin full-thickness skin graft for managing complex anterior urethral strictures: surgical outcomes and predictive factors.

To describe outcomes of staged-urethroplasty in complex anterior urethral strictures using full-thickness-skin-graft (FTSG) harvested from the hairless groin area, and to identify factors influencing successful outcomes. Through retrospective chart review, we identified a total of 67 men who underwent the first-stage operation (grafting) using groin-FTSG for staged-urethroplasty to treat complex anterior urethral strictures unsuitable for one-stage urethroplasty. Among these, 59 underwent the second-stage operation (tubularization) at a median duration of 5.1-months after grafting. Patients were assessed for outcomes as scheduled after tubularization outcomes were analyzed only for 48 patients for whom ≥ 1-year follow-up data after tubularization were available. Their mean follow-up duration was 27.1months. Success was defined as achieving physiologic voiding without requiring further procedures. Median stricture-length was 5.5cm in all 67 patients. After grafting, neourethral-opening-narrowing occurred in 18. Partial graft-loss occurred in 8, of whom only 3 underwent re-grafting. The percentage of patients who achieved successful outcomes was 81.3%. Improvements in maximum-urine-flow-rate and post-void-residual-urine-volume were maintained until the last follow-up visit. A urethrocutaneous-fistula occurred in one patient, while meatal-stenosis occurred in two. On multivariate-regression-analysis, the presence of neourethral-opening-narrowing was the only predictor of non-success after tubularization. Furthermore, the presence of hypertension, longer stricture-length, and a history of prior direct-vision-internal-urethrotomy were predictors of the occurrence of neourethral-opening-narrowing. Staged-urethroplasty using groin-FTSG is well worth considering as a useful therapeutic option for complex anterior urethral strictures, with an acceptable success rate and low morbidity. The absence of neourethral-opening-narrowing after the first-stage operation leads to success.

Urethroplasty technological changes for the treatment of male urethral stricture

Urethroplasty is an important method to treat male urethral stricture. Nowadays, urethroplasty mainly includes two types: anastomotic urethroplasty and substitution urethroplasty. Anastomotic urethroplasty mainly includes primary anastomosis urethroplasty and non-transecting anastomotic urethroplasty. Substitution of urethroplasty mainly includes staged urethroplasty and one-stage urethroplasty. Substitution materials always are chosen by pedicle skin flap and free mucosal graft. Anastomosis urethroplasty has shown good results in short bulbar urethral stricture and posterior urethral stricture after pelvic fracture. Among them, non-transecting anastomosis urethroplasty has become a new surgical method for iatrogenic, single, short or non-occluded stenosis. At present, the one-stage substitution urethroplasty is the most widely used. However, there are still many complicated cases that must be solved by staged urethroplasty. Pedicle skin flap and oral mucosa are widely used as substitutes at present. How to select the best surgical procedure and substitute materials individually would be the problem worthy of attention in the future. Accumulating more long-term follow-up data is helpful for objective comparison of various surgical procedures and grafts.

Androgen stimulation before the one-stage urethroplasty with preputial island flap (the Duckett's procedure) for proximal hypospadias repair.

article: Androgen stimulation before the one-stage urethroplasty with preputial island flap (the Duckett’s procedure) for proximal hypospadias repair - Minerva Urology and Nephrology 2022 October;74(5):641-2 - Minerva Medica - Journals

One-stage tubularized urethroplasty using the free inner plate of the foreskin in the treatment of proximal hypospadias

ObjectiveThis study summarizes the short-term efficacy of the one-stage tubularized urethroplasty using the free inner in proximal hypospadias.MethodsA retrospective analysis was conducted on 42 patients with proximal hypospadias. All cases were treated with one-stage tubularized urethroplasty from January 2020 to June 2021. The postoperative complications like urethral fistula, urethral stricture, diverticulum, and split penis head were recorded.ResultsPatients were followed up for 3 to 15 months (an average of 8.5 months). A total of 26 cases (62%) were repaired without any complication. Five patients (11.9%) developed urinary fistulas and underwent secondary repair: three cases with anastomotic fistulas and two cases of coronal fistulas. Nine patients (21.4%) had stenosis of the head segment of the penis, six (14.3%) had stenosis that was relieved by urethral dilatation combined with topical mometasone furoate 1 month after urethral catheter removal. Two patients (4.8%) had severe stenosis with secondary surgical stenosis incision, and one (2.4%) had combined urethral diverticulum in which urethral stenosis incision and diverticulectomy were performed.ConclusionsTubularized urethroplasty using the free inner bears the advantages of easy access, reduced short-term complications, low incidence of diverticula.

FACTORS ASSOCIATED WITH URETHROCUTANEOUS FISTULA COMPLICATION IN HYPOSPADIAS PATIENT AFTER URETHROPLASTY IN FATMAWATI GENERAL HOSPITAL: A RETROSPECTIVE COHORT DESIGN

Objective: This study compared several factors that are thought to contribute to the incidence of complications of urethroplasty fistula after urethroplasty, including meatus location, degree of chordee, surgical technique, and postoperative stent type. Material & Methods: This study is an analytical study with retrospective cohort design. After adjusting to the inclusion and exclusion criteria, 89 subjects with proximal hypospadias were subjected to urethroplasty at Fatmawati General Hospital, Jakarta from 2016 to 2019. An analysis of the relationship between several variables and the incidence of uretrocutaneous fistula was analyzed. Results: There was no significant difference between the one-stage and two-stage urethroplasty technique on the incidence of urethrocutaneous fistula (p = 0.063). There was no significant difference between the degree of chordee and complications of urethrocutaneous fistula after urethroplasty (p = 0.677). The relationship between the use of silastic stent, catheter, or cystostomy type was also not significant in complications of urethrocutaneous fistula (p = 0.576). The location of the urethral meatus also did not have a significant role in predicting the incidence of post-urethroplasty urethrocutaneous fistula (p = 0.169). Conclusion: Surgical technique (one stage and two stages), type of stent, degree of chordee, and location of the urethral meatus, did not have a significant correlation with the incidence of urethrocutaneous fistula in hypospadias patients after urethroplasty.

Revisiting One-Stage Urethroplasties for Distal Urethral Strictures.

Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7–84.9 years), the mean stricture length was 1.1 cm (0.5–1.5) and the mean follow-up was 42.5 months (28–61.3). Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.

Staged transverse preputial island flap urethroplasty for some proximal hypospadias with moderate-to-severe chordee

BackgroundWe aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children.MethodsNighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 were evaluated retrospectively. Patients were divided into two groups: one-stage TPIF urethroplasty group (n = 44) and staged TPIF urethroplasty group (n = 48). We noted and compared the postoperative complications, including urethrocutaneous fistula, urethral diverticula, residual penile curvature, and urethral stricture in both groups.ResultsBoth groups were followed up for 1–5 years, with an average of 3 years. No cases of residual or recurrence of penile chordee were reported in either group. In Group A, 9 patients (9/44, 20.4%) had postoperative urethrocutaneous fistula, and all patients underwent urinary fistula repair or urethroplasty. In Group B, postoperative urethrocutaneous fistula occurred in 2 cases (2/48, 4.1%), and one patient developed a urethrocutaneous fistula after the first operation, which was successfully repaired during the second operation. A urethrocutaneous fistula occurred in 1 case after completion of the second-stage operation; urethral fistula repair was performed successfully 6 months later. There were 2 cases of urethral stricture in Group A (2/44, 4.5%) and none in Group B. There were 6 cases of urethral diverticulum in Group A (6/44, 13.6%) and no cases of urethral diverticulum in Group B. The operative success rates were 61.3% and 95.8% in Group A and Group B, respectively (P < 0.001).ConclusionsCompared with one-stage TPIF urethroplasty, staged TPIF urethroplasty in the treatment of certain cases of primary proximal hypospadias with moderate-to-severe chordee resulted in fewer postoperative fistulas, urethral strictures and urethral diverticula. The staged TPIF urethroplasty procedure was effective in reducing the operation difficulty and complication rate of hypospadias, improving the curative effect of complex hypospadias and having good clinical application value.

Клинические особенности стриктур спонгиозного сегмента уретры, подлежащих многоэтапной уретропластике или постоянной уретростомии

Introduction. Extended spongy urethral strictures require the use of plastic surgery techniques. In most cases, a one-stage urethral repair can be performed. However, staged urethroplasty and permanent urethrostomy are important in patients with extremely complex urethral strictures. Purpose of the study. To determine the clinical features of spongy urethral strictures, which cannot be cured by one-stage urethroplasty, but are subject to multistage plastic or permanent urethrostomy. Materials and methods. The study included 158 patients who underwent surgery for urethral strictures in 2010 − 2019. Inclusion criteria: spongy urethral strictures requiring staged urethroplasty or permanent urethrostomy. Exclusion criteria: age&lt;18 years, proximal urethral strictures, urethra-vesical anastomosis and bladder neck stenosis, previously untreated congenital anomalies (hypospadias and epispadias), and history of any other urethral surgery not meeting the inclusion criteria. Results. The age of the patients ranged from 18 to 88 years. Iatrogenic (34.8%) and inflammatory (32.3%) urethral lesions predominate in the structure of etiological factors with the most common penile localization of narrowing (43.7%). The length of strictures in half of the patients exceeds 6 cm; a quarter of the sample has subtotal and total spongy urethral lesions. The proportion of recurrent urethral strictures is 56.3%. The average duration of the urethral stricture disease reaches 8 years. In 61.3% of cases, the disease is accompanied by complications from both local tissues and organs of the urinary and reproductive systems. Conclusion. Clinical evaluation of patients with spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy reveals a particular severity of urethral stricture disease. This category of patients has a high risk of unsuccessful outcomes with one-stage surgery. In these cases, patients require a multi-staged urethroplasty or a permanent urethrostomy.

Оценка эффективности оперативного лечения рецидивной стриктуры уретры

INTRODUCTION The recurrent course of the disease stricture is a complex problem for both the patient and the operating surgeon and requires an integrated approach to treatment only in expert centers. PURPOSE OF THE STUDY To assess the effectiveness of methods of surgical treatment of recurrent urethral strictures. MATERIALS AND METHODS At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, an analysis of the results of surgical treatment of patients with recurrent urethral stricture from 2012 to 2020 was carried out. This work included patients who underwent surgical treatment for recurrent urethral stricture. A total of 120 men were involved in the work. The median length of the stricture was (min-max) - 2 (0.5-16 cm). In 95 (79.1%) patients, stricture of the bulbous urethra, in 15 (12.5%) - in the penile urethra, in 2 (1.7%) patients had panurethral stricture, in 6 (5.0%) - membranous urethra and in 2 (1.7%) - meatus. All patients were divided into two groups: with recurrent urethral stricture after primary DVIU (group I, n=77) and recurrent urethral stricture after primary urethroplasty (group II, n=43). Depending on the method of surgical treatment of recurrent urethral stricture, patients in group I were divided into 4 subgroups. Repeated DVIU + 3 months Autocatheterization - 16 (20.8%) patients; End-to-end urethroplasty - 37 (48.1%) patients; one-stage urethroplasty with a buccal graft or skin graft - 22 (28.6%) patients; multistage urethroplasty or perineostomy - 2 (2.5%) patients. Group II was also divided into 4 subgroups. DVIU - 17 (39.5%) patients; end-to-end urethroplasty - 6 (13.9%) patients; one-stage urethroplasty with a buccal graft or skin graft - 9 (20.9%) patients; multistage urethroplasty - 11 (16.7%) patients. Median Qmax - 4.68 ml/sec. Preoperative cystostomy was observed in 31 (25.8%) patients. RESULTS The median follow-up was 24 months (range 12 to 76 months). Depending on the method of surgical treatment of recurrent urethral stricture, the effectiveness of DVIU according to strict indications was 75.7%. End-to-end urethroplasty showed an efficiency of -88,4%. One-stage augmentation urethroplasty had an efficiency of -77,4%, and multi-stage urethroplasty showed an efficiency of 84.6%. The IPSS value for the observation period 2 years was 2.6+/-0.9 points. The average value of Qmax at the time of observation was 19.4+/-7.1 ml/sec. The effectiveness of the treatment was 82%. During the follow-up period, a relapse was noted in 22 (18%) patients. The overall effectiveness of the treatment of recurrent urethral stricture, taking into account the treatment of recurrent cases of disease recurrence, was 97.5%. CONCLUSIONS Urethroplasty is the treatment of choice for recurrent urethral strictures, which has been shown to be more effective than DVIU. However, the results of urethroplasty for recurrent strictures are worse than for primary strictures.

MP03-10 ONE-STAGE BUCCAL MUCOSAL GRAFT URETHROPLASTY FOR LICHEN SCLEROSUS RELATED URETHRAL STRICTURE DISEASE: A META-ANALYSIS AND SYSTEMATIC REVIEW

INTRODUCTION AND OBJECTIVE:Performing one-stage urethroplasty in patients with lichen sclerosus (LS) related urethral stricture disease is hotly debated among reconstructive urologists. Prior studi...

MP56-16 ONE-STAGE URETHROPLASTY USING DORSAL-VENTRAL BUCCAL MUCOSAL GRAFT: LONG-TERM, VALIDATED PATIENT REPORTED OUTCOMES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-16 ONE-STAGE URETHROPLASTY USING DORSAL-VENTRAL BUCCAL MUCOSAL GRAFT: LONG-TERM, VALIDATED PATIENT REPORTED OUTCOMES John Barnard, and Joel Gelman John BarnardJohn Barnard More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The dorsal-ventral or "double face" buccal mucosa graft urethroplasty (BMG-U) via a dorsal approach was first described in a series of 18 patients in 2014. When the corpus spongiosum is intact, this surgery is appropriate for a 1-stage reconstruction where there is obliteration or near obliteration of a segment too long for anastomotic or augmented anastomotic urethroplasty (AAU). This technique is also a non-transecting alternative to AAU for shorter strictures unsuitable for onlay repair alone. Our objective was to provide global, validated and urethroplasty specific patient reported outcomes (PROMs) with this technique with up to 21 year follow up. METHODS: Patients were prospectively enrolled in our IRB approved urethroplasty outcomes study from 1998 to present. Anatomic success was assessed by cystoscopy >4 months after surgery. Long-term outcomes were assessed using the International Prostate Symptom Score (IPSS) and a 6Q-LUTS urethroplasty specific PROM, the Sexual Health Inventory for Men (SHIM), and the Male Sexual Health Questionnaire Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). A Student’s t-test evaluated differences in means for the PROMs with significance at p < 0.05. RESULTS: 38 patients underwent BMG-U. Mean age at surgery was 50.5 years (19.2-77.5). Mean follow-up was 78 months (13.4-262.4). The anatomic success rate was 97.2%, and the long-term functional success was 97.4%. Significant improvement was observed in IPSS (including quality of life metric) and 6Q-LUTS post-operatively, and this difference was sustained. No difference in SHIM or MSHQ-EjD-SF was observed. Overall satisfaction was 97.4%, and 91.9% stated they would undergo surgery again knowing their outcome. CONCLUSIONS: The dorsal-ventral BMG-U via a dorsal approach is associated with high patient satisfaction, and validated PROMs demonstrate lasting effect with no significant detriment to erectile and ejaculatory function. It was recently reported that for bulbar strictures, AAU was an independent risk factor for recurrence. Although we did not perform a comparative study, we speculate that the absence of urethral transection may be a factor contributing to a successful outcome that is comparable to the published results for strictures amenable to dorsal onlay substitution urethroplasty. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e975-e975 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Barnard More articles by this author Joel Gelman More articles by this author Expand All Advertisement Loading ...

P0393 - One-stage urethroplasty for lichen sclerosus related urethral stricture disease: A meta-analysis and systematic review

P0393 - One-stage urethroplasty for lichen sclerosus related urethral stricture disease: A meta-analysis and systematic review

The learning curve in proximal hypospadias repair

Although the learning curve in various surgical procedures is increasingly discussed, there have been only a few reports about the learning curve especially in proximal hypospadias repair. To evaluate the learning curve in one-stage hypospadias repair for proximal hypospadias. We retrospectively reviewed 73 cases of primary hypospadias repair by a single pediatric urologist using one-stage urethroplasty with a preputial skin graft between 2007 and 2018. The overall complication rate included fistula, glans dehiscence, and meatal stenosis. To analyze the impact of the surgeon's experience on the complication rate, we compared the complication rates among different groups of 20 consecutive cases each. In addition, we graphed the actual data of the operative time and cumulative complication rate to evaluate the learning curve. The cumulative complication rate was defined as the surgeon's complication rate (the number of complications accumulated at a time/number of cases at that time). The median age at surgery was 18 months (range: 7-87). The median follow-up was 40 months (range: 3-114). In total, 13 (18%) children had complications: 9 fistulae, 3 glans dehiscence, and 2 metal stenoses. The analysis of each 20 cases revealed that the complication rate declined over time as the surgeon became more experienced. It was mainly attributed to a decline of the fistula rate. The diagram of the operative time showed a reduction with the increasing surgical experience. Additionally, the diagram of the cumulative complication rate demonstrated a plateau after 50 cases. Our study showed the positive impact of surgeon experience on the outcome of one-stage repair for proximal hypospadias. In addition, the learning curve in proximal hypospadias repair stabilized after about 50 cases although the supervision of experienced surgeons is required during the early phase of learning curve.

АНАЛИЗ ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ ДВУХ ОПЕРАТИВНЫХ МЕТОДИК ПРИ ЛЕЧЕНИИ ПОСЛЕДСТВИЙ ТРАВМ УРЕТРЫ

Objective: To analyze the results of application of the two surgical techniques in the treatment of the consequences of urethral injuries (CUI). Methods: 38 patients aged 16.4±1.9 years with CUI were examined. CUI were localized in the area of the scaphoid fossa (n=3), the penile part (n=9), the bulbous region (n=6). Multi-site and panurethral lesions were noted in 8 and 12 cases, respectively. Additional research methods included ultrasound examination of the bladder, uroflowmetry, residual urine measurement, and, if necessary, retrograde and voiding urethrography. The patients underwent two types of surgical intervention: one-stage (16 patients, 1st group) and two-stage (22 patients, 2nd group) urethroplasty using a buccal mucosal flap. The results of surgery were assessed by ascending urethrography and uroflowmetry. The follow-up period ranged from 6 to 24 months. Results: The immediate and long-term results between the two groups showed significant difference. According to uroflowmetry data, the main indicator of the effectiveness of surgical intervention was a stable retention of maximum urine flow rate at least 15 ml/sec. In the 1st group, there was one case of early wound dehiscence with the formation of a fistula. In the 2nd group, early divergence was observed in 8 cases, it was also accompanied by formation of fistulas. These complications required additional surgical intervention; their correction was deferred. Conclusion: One-stage urethroplasty using a buccal mucosal flap for CUI proved to be safer and more effective compared to the two-stage technique Keywords: Consequences of urethral injury, urethrography, uroflowmetry, buccal flap.

Коррекция стенозов уретры после оперативных вмешательств по поводу проксимальных форм гипоспадии у детей

Aim Urethral stenosis is one of the serious complications after proximal hypospadias repair. A variety of techniques has been suggested for its correction, such as urethral dilation using bougies, endoscopic incisions and one- or two-staged urethroplasty with buccal mucosa. The aim of our study was to improve results of urethral stenosis correction in children after multiple proximal hypospadias repairs. Materials and methods A total of 24 patients with urethral stenosis after proximal hypospadias repairs underwent treatment in the Department of Uroandrology of the Russian Childrens Clinical Hospital from 2015 to 2019. The age of the patients was from 3-17 years (average - 4.2) with penoscrotal form of hypospadias in 12, scrotal in 8, and perineal in 4 patients. All children previously underwent 2-8 hypospadias repairs. Patients were divided into 2 groups. In group I, 16 patients had urethral stenosis from the glans of the penis to the penoscrotal area, urethral diameter of 3-4 Ch and ventral penile curvature of 45-60o. These patients were treated with a two-staged urethroplasty, similar to Brackas technique. In group II, 8 patients with urethral stenosis in the penile shaft area, urethral diameter of 6 Ch, without penile curvature were included. They underwent to a one-stage urethroplasty with buccal mucosa graft, which was sutured on the dorsolateral aspect of the urethra, with a formation of the age-appropriate urethra (Dorsolateral Inlay). Results All patients in both groups had successful results with flow rate of 8-12 ml/sec. Conclusions The correction of urethral stenosis in children after proximal hypospadias repairs can be performed using buccal mucosa. In cases of long urethral stenosis, urethral diameter of 3-4 Ch, penile curvature, and scarring of the penile skin, a two-staged urethroplasty is recommended. In patients with stenosis of the penile shaft, urethral diameter of 6 Ch and lack of penile curvature, a one-stage urethroplasty with buccal mucosa fixation on the dorsolateral aspect of the urethra (Dorsolateral Inlay) allows to achieve successful results.

Independent risk factors for failure after anterior urethroplasty: a multivariate analysis on prospective data.

To identify independent risk factors for urethroplasty failure in a prospective dataset. Since 2008, data of all male patients undergoing urethroplasty at Ghent University Hospital have been prospectively recorded and maintained. This analysis excluded: posterior strictures, strictures of the perineostomy, urethral malignancy-related strictures, age < 18years and follow-up < 1year. Postoperatively, a voiding cysto-urethrography (VCUG) was performed after 2weeks and in absence of significant contrast extravasation, the transurethral catheter was removed. Patients were followed after 3m, 12m and annually thereafter. Failure was defined as stricture recurrence requiring additional urethral intervention(s). Uni- and multivariate Cox regression analyses were performed on the entire patient cohort and for one-stage urethroplasty (OSU) at specific locations. In total, 474 patients were included. Median follow-up was 62m (IQR 35-91). Significant extravasation was present in 6.9%. Bulbar stricture location was identified as independent protective factor for urethroplasty failure (HR 0.44; p = 0.046) and significant extravasation at first VCUG was identified as independent risk factor for urethroplasty failure (HR 2.86; p = 0.005). Cox regression analyses for OSU at specific locations could not identify other risk factors. All but one (89%) of the failures preceded by significant extravasation at first VCUG occurred within 2years of follow-up whereas 44% of the failures with no or insignificant extravasation at first VCUG occurred after 2years of follow-up (p = 0.03). Bulbar stricture location is an independent protective factor for urethroplasty failure. Significant extravasation at first urethrography is an independent risk factor for urethroplasty failure and is associated with earlier stricture recurrence than other failed cases.

Oral ucosal Grafts in One-stage Urethroplasty for Panurethral Strictures

Objectives: Panurethral strictures are complex and extensive strictures that involve the penile and bulbar urethra. Management of these patients is challenging. In the last two decades, oral mucosal grafts have gained widespread popularity as the most versatile substitute tissue for urethral reconstruction. This paper presents the short- term outcome of our experience in the use of oral mucosal grafts in one-stage urethroplasty in patients with panurethral strictures. Patients and Methods: Between April 2012 and January 2017, 62 men were evaluated and had one-stage oral mucosa urethroplasty for panurethral strictures. Results: The mean age of the patients was 50 years with a range of 11-75 years. Aetiological factors were poorly treated urethritis 39 (62.9%), indwelling urethral catheterization 18 (29.0%), trauma 1 (1.6%) and lichen sclerosis 1 (1.6%). Reasons for urethral catheterization were for intraoperative monitoring 9 (50.0 %), relief of acute urine retention 4 (22.2%) and others 4 (22.2%). Fifty-two patients (83.9%) had preliminary urinary diversion by supra-pubic cystostomy before urethroplasty. The mean OMG length was 11.7cm and donor sites were buccal in 37 (59.7%), combined buccal and labial in 20 (32.3%). Fifty-seven (88.7%) patients had satisfactory voiding on removal of the urethral catheter. Donor site complications were reactionary haemorrhage 1 patient, stay suture lip injury 1, pain and numbness in 6 (9.6%) patients. Superficial wound infections were recorded in 6(9.7%) patients. The duration of follow-up ranged from 1-29 months; mean 6 months. There was no mortality. Conclusion: Panurethral strictures are common in our practice mainly resulting as complication of poorly treated urethritis and urethral catheterization. Urethral reconstruction by one-stage oral mucosa graft urethroplasty is feasible, has good, short-term outcome though it may be associated with minor donor site complications. Larger number of patients and longer- term follow up are needed to assess the durability of the procedure

Results of One-Stage Urethroplasty for Hypospadias in Pediatrics – Single Surgeon’s Experience

Introduction: Hypospadias repair is a challenging technique in pediatric urology with a long learning curve. This study presents the results of urethroplasty performed by a single surgeon to repair hypospadias in children and compares the surgical outcomes at different periods. Materials and Methods: From January 2009 to February 2016, patients who were less than 18 years old and were operated for hypospadias were retrospectively reviewed and divided into two groups: group I (from January 2009 to February 2012) and group II (from March 2012 to February 2016). All operations were performed by the same pediatric surgeon, andsurgical outcomes of the two periods were compared. Results: This study considered150 patients (69 in group I/81 in group II). The Mean operative age was 30.4±32.7 months in group I and 33.6±43.3 months in group II(p=0.309). The selected procedures mainly depended on the subjective anatomical analysis in the operating room and the surgeon’s preference. The mean follow-up duration was 21.7±28.31 months in group I and 13.6±16.6 months in group II (p=0.033).The overall complication rate was 44.9% in group Iand 35.8% in group II (p=0.316). The incidence of glanular disruption significantly decreased from 21.7% to 6.2% (p=0.007) because of the wide dissection of the glanular wings and the deep incision of the urethral plate, which led to tension-free sutures for glanular reconstruction. Conclusions: One-stage repair of hypospadias may achieve satisfactory outcomes in cosmetic appearance and voiding function. Surgical outcomes could be improved by increasing practice.

265 Perioperative Outcomes of Male One-Stage Urethroplasty; Outcomes From a National Prospective Database

There are few surgeons who perform a large number of male one-stage urethroplasties. Thus, the majority of the studies evaluating this specific surgery are retrospective and/or single-institution studies. We sought to assess the patient and perioperative characteristics of male one-stage urethroplasty using a large multi-institutional prospectively collected database. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2007-2013) was queried using Current Procedural Terminology (CPT) codes for one-stage urethroplasty (53410, 53415, 53431). Medical comorbidities, length of stay (LOS), operative time (pOT), 30-day complications (including infectious, thromboembolic, renal, cardiac, pulmonary, and neurologic events), and need for blood transfusion, re-intubation, or reoperation were analyzed. Four hundred eighty male patients having undergone single stage urethroplasty were identified, with a median age of 48 years at the time of surgery (18-85). Median body mass index (BMI) was 29 (17-65) and median ASA score was 2 (1-3). The median procedure length was 167 minutes (65-507 minutes), and the median length of stay was 1 day (0-17). Twenty-nine patients developed post-operative complications within 30 days of surgery (6.0%): 13 urinary tract infections (UTIs), 3 superficial wound infections, 4 deep wound infections, 3 wound dehiscences, 1 post-operative pneumonia, 1 deep vein thrombosis, 2 myocardial infarctions, and 2 cases of sepsis. Two patients required blood transfusions, and 2 different patients required reoperation. There were no 30-day mortalities.

Reoperation methods and effectiveness of urethral stricture after urethroplasty of hypospadias

To discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness. Between September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation (74 cases) and urethral advancement (6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy (10 cases), urethrotomy and one-stage urethroplasty (26 cases), and urethrostomy (51 cases) including 43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis. One hundred and fifty-four patients were followed up 6-86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated. If it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.