One-stage Urethroplasty Research Articles

One-stage urethroplasty for strictures at a rural hospital

Introduction: St Mary’s Mission Hospital manages many inflammatory and traumatic urethral strictures. Previously, we treated strictures with dilatation, but high recurrence and poor patient satisfaction necessitated adoption of reconstructive procedures since 2017.Objective: To review the scope, outcome and complications of urethroplasties using data collected prospectively.Methods: All cases of one-stage urethroplasty were included. Patient biodata and pre-operative adverse factors were collected and analyzed.Results: 23 male patients ranging in age from 24 to 74 years were studied: 9 strictures were inflammatory (40%), 9 were traumatic (40%), 3 (20%) were recurrent. Nineteen strictures were in the bulbar urethra (83%), 2 were cases of penile strictures and 1 case each of pan-urethral stricture and pelvic floor urethral distraction defect. Of the 23 procedures, 13 were simple anastomosis (57%), 5 were dorsal buccal mucosa graft (BMG) urethroplasty (22%), 2 were cases of non-transecting anastomotic urethroplasty, and 1 case each of ventral BMG urethroplasty and Johansson’s and Kulkarni’s panurethroplasty. The overall complication rate was 40% (9 patients). Four patients (17%) had recurrence; 2 had fistula and 1 case each of persistent UTI, erectile dysfunction and periurethral abscess. Three of the four recurrences had undergone BMG urethroplasty. All cases of simple anastomosis had no recurrence.Conclusion: Our centre has embraced diverse urethroplasties for a wide scope of patients. This study found a significant complication rate for substitution urethroplasties, suggesting a need for careful patient selection and an improvement in technique.Keywords: Stricture, Urethroplasty, One-stage, Complications, Outcome

Update on managing anterior urethral strictures

A number of techniques have been described for managing anterior urethral strictures in men. In this review, we aimed to summarize contemporary considerations regarding the holistic management of such strictures. The efficacy of reported outcomes is compared to provide evidence-based treatment recommendations. For anterior urethral strictures, durable long-term success rates of >90% may be achieved if the procedure is performed in capable hands at a high-volume referral center, even in recurrent strictures after previous open reconstruction. A one-stage urethroplasty is preferable to avoid a protracted treatment course with multiple interventions after dilation and direct vision internal urethrotomy. Staged urethroplasties are useful in complex anterior strictures providing durable success rates. In addition, perineal urethrostomy represents a valid last resort option with sufficient objective and subjective results. A follow-up evaluation should incorporate objective assessments such as radiographic and functional diagnostics as well as subjective, validated, and disease-specific patient-reported outcome measurement tools to allow for a better comparability and to improve individual risk prediction.

CR09 - Penile stricture and lichen sclerosus: One-stage urethroplasty with buccal mucosa graft

CR09 - Penile stricture and lichen sclerosus: One-stage urethroplasty with buccal mucosa graft

Onlay urethroplasty with unilatreral parameatal penopreputial flap

Background/purpose: One-stage urethroplasty with bilateral parameatal foreskin flap was first described by Tomohiko Koyanagi for cases of severe hypospadias. He also introduced the onlay urethroplasty with unilateral parameatal foreskin flap for distal hypospadias. Emir and colleagues in 2000 devised a modification of the bilateral Koyanagi repair of severe hypospadias. We in turn modified the (unilateral) Koyanagi technique for the repair of hypospadias without chordee. The aim of this study is to analyze the results of the Mansoura modification of the (unilateral) Koyanagi technique as a one-stage repair of hypospadias without chordee. Patients and methods: During the period from March 2013 to March 2015, 30 patients underwent treatment of hypospadias without chordee using the modified onlay urethroplasty with unilatreral parameatal penopreputial flap (modified unilateral Koyanagi technique). Results: The patients’ age at the time of surgery ranged from 6 to 30 months. Sixteen cases had distal penile meatus, 10 had mid-penile meatus; and four had proximal penile meatus. The follow-up ranged from 3 months to 1 year. Primary success occurred in 28 (93%) cases with accepted cosmetic appearance. Complications occurred in two (7%) cases, in the form of urethrocutaneous fistula. There was no incidence of meatal stenosis nor recession, urethral stricture or flap necrosis. Conclusion: The Mansoura modification of the onlay urethroplasty with unilatreral parameatal penopreputial flap (unilateral Koyanagi) is applicable for all forms of hypospadias without chordee showing acceptable results. Keywords: hypospadias, modified Koyanagi, one-stage urethroplasty, onlay urethroplasty with parameatal penopreputial flap, original Koyanagi

Comparative effectiveness of initial, repeat, and secondary anterior one-stage buccal mucosal graft urethroplasty

Comparative effectiveness of initial, repeat, and secondary anterior one-stage buccal mucosal graft urethroplasty

A new modification of the Duckett technique for one-stage repairing urethral plate transected hypospadias: Another option for severe hypospadias?

The study aimed to evaluate the new modification of the Duckett technique in decreasing the incidence of urethral strictures for urethral plate transected hypospadias and also explored its clinical application. Thirty-three patients (aged 7months to 12years, mean age 2.8years) who underwent repair of primary hypospadias using the new one-stage urethroplasty were enrolled. Clinical data, including cosmetic and its complications, and uroflowmetry data were documented. Uroflowmetry data of 19 patients who underwent Duckett urethroplasty were used as a comparison. The length of the urethral defect ranged from 2.5 to 5.0cm. The postoperative follow-up was 14-30months. Ten patients (30.3%) had fistulas; no patients had strictures or diverticula. All ten fistulas were small (<0.5cm) and repaired with fistula repairing operation. The appearance of the penis remained satisfactory, and the meatus was located in the normal anatomic position. Among 17 patients who underwent uroflowmetry, all patients were bell-shaped or platforms, and Q max was 7.37±2.45ml/s. Compared with 14 of 19 patients who underwent Duckett urethroplasty, the urethral function achieved with new one-stage urethroplasty was significantly better (p<0.05). The incidence of strictures was dramatically lowered in patients with proximal hypospadias. Small fistulas are common complications and can be repaired easily. Based on the uroflow pattern results, the quality of neourethra and function of it were better than Duckett urethroplasty. These preliminary results suggested that the modified procedure seems to be reliable and can be a suitable option for proximal hypospadias.

One-stage Penile Urethroplasty Using Oral Mucosal Graft and Glue

BackgroundRepair of penile urethral strictures is a challenging problem for which different techniques have been suggested. ObjectiveTo describe a new surgical technique for one-stage penile urethroplasty using an oral graft and glue, and to assess its safety and efficacy. Design, setting, and participantsA retrospective review of medical records for patients who underwent one-stage penile urethroplasty using oral mucosa and glue from February 2013 to October 2014 was performed. Surgical procedureThe penile urethra was opened and the urethral plate was incised to create a wide window within which the oral graft was pasted with glue. The urethra was sutured over the catheter. Outcome measurements and statistical analysisClinical data were collected in a database. Intraoperative and postoperative complications and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitationsFourteen patients were included in the study. Median operative time was 60min. The median postoperative stay was 3 d. Three intraoperative and one postoperative complication occurred. In all patients, voiding cystourethrography 2 wk after surgery failed to show urethral fistula or sacculation. No patients complained of penile chordee or sexual dysfunction after surgery. Median follow-up was 16 mo. Among the 14 patients, 12 (85.7%) procedures were successful and two (14.3%) were failures. Study limitations include the small sample size and short follow-up. ConclusionsAn in vitro study and a one-stage reconstruction of penile urethral strictures with an oral mucosa graft and glue showed that the procedure is safe and efficient, but further studies including larger series of patients and longer follow-up are required. Patient summaryWe report on the repair of penile urethral stricture using one-stage urethroplasty with oral mucosa and glue. This new technique was safe and effective, with limited complications and satisfactory outcomes. We plan to increase the use of this technique in the future.

MP52-12 RECONSTRUCTION OF LICHEN SCLEROSUS RELATED URETHRAL STRICTURES: OUTCOMES OF LONG PENILE AND PANURETHRAL STRICTURES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2016MP52-12 RECONSTRUCTION OF LICHEN SCLEROSUS RELATED URETHRAL STRICTURES: OUTCOMES OF LONG PENILE AND PANURETHRAL STRICTURES David Chapman and Keith Rourke David ChapmanDavid Chapman More articles by this author and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.488AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lichen sclerosus (LS) related urethral strictures require unique treatment considerations. The two most common surgical dilemmas are how best to reconstruct long penile and panurethral strictures. The purpose of this study is to assess the relative outcomes of reconstruction for both long penile and panurethral strictures caused by LS. METHODS A retrospective review was performed on 975 urethroplasties performed by a single urologist from 2003 to 2014. Sixty-five patients were identified with lichen sclerosus related urethral strictures. Outcomes in long (>2cm) isolated penile strictures and panurethral strictures (>12cm) were examined. Penile strictures were reconstructed with either a staged approach or dorsal onlay using buccal mucosa. Panurethral strictures were treated with either dorsal onlay or urethrostomy augmented with buccal mucosa. The primary outcome measure was urethral patency >16Fr on follow-up cystoscopy and secondary outcomes were 90-day complications, and adverse change in sexual dysfunction or chordee. Outcomes were compared using a two-tailed Fisher’s Exact test. RESULTS Fifty-one patients (mean age 49.6 years) underwent either penile urethroplasty or panurethral reconstruction for LS strictures. Twenty-six patients underwent urethroplasty for penile strictures with a mean stricture length of 5.6cm and overall success of 80.8%. There was no difference between patency rates of staged urethroplasty and one-stage urethroplasty using a dorsal onlay (82.4% vs. 77.8% respectively; p=0.99) with a mean follow-up of 18 months. Complications did not significantly differ between staged and dorsal onlay techniques (p=0.22) nor did adverse change in sexual function/chordee (5.8% vs. 22.2%; p=0.27). The twenty-five patients reconstructed for panurethral strictures had a 48% success rate with a mean follow-up of 49.1 months. Mean stricture length was 14 cm. There was no difference between onlay urethroplasty and augmented urethrostomy with regard to success (40% vs. 53.3%;p=0.69), complications (30% vs. 26.7%;p=0.99) or adverse change in sexual function (p=0.26). Overall, penile strictures fared significantly better than panurethral strictures (80.8% vs. 48% success; p=0.02). CONCLUSIONS Reconstruction of isolated penile urethral strictures related to lichen sclerosus yields satisfactory outcomes with no noted difference between staged and onlay techniques. True panurethral strictures fare worse regardless of which techniques are used. Further advances in this patient group are sorely needed. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e693 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David Chapman More articles by this author Keith Rourke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The Selection of Procedures in One-stage Urethroplasty for Treatment of Coexisting Urethral Strictures in Anterior and Posterior Urethra

To explore selection of the procedures in one-stage urethroplasty for treatment of coexisting urethral strictures in the anterior and posterior urethra. Between 2008 and 2014, a total of 27 patients with existing strictures simultaneously at anterior urethra and posterior urethra were treated in our hospital. Two types of procedures were selected for treatment of the anterior urethral strictures. A penile skin flap and the lingual mucosa were used for augmented urethroplasty in 20 and 7 cases, respectively. Three types of procedures, namely, non-transecting end-to-end urethral anastomosis (n = 3), traditional end-to-end urethral anastomosis (n = 17), other grafts substitution urethroplasty, including pedicle scrotal skin urethroplasty (n = 2), and lingual mucosal graft urethroplasty (n = 5), were utilized in the treatment of posterior urethral strictures. The patients were mean followed up 30 months with an overall success rate of 88.9%. The majority of the patients exhibited wide patent urethras on retrograde urethrography and the patients' urinary peak flow ranged from 14.2 to 37.9 ml/s. Complications developed in 3 patients (11.1%). Of the 17 patients who underwent traditional urethral end-to-end anastomosis, urethral strictures occurred in 2 patients at 4 and 6 months after the operation. These patients achieved a satisfactory voiding function after salvage pedicle scrotal skin urethroplasty. A urethral pseudodiverticulum was observed in another patient 9 months after pedicle penile flap urethroplasty; and after a salvage procedure, he regained excellent voiding function. Synchronous anterior and posterior strictures can be successfully reconstructed with a combination of substitution and anastomotic urethroplasty techniques.

The selection of procedures for the treatment of panurethral stricture secondary to lichen sclerosus and the histological evidence of urethral involvement

Objective To explore the procedure selection and outcomes of treatment for the patients with severe panurethral strictures secondary to lichen sclerosus (LS) and evaluated the bulbar urethral specimens histologically. Methods Seventy-eight patients with severe panurethral strictures of LS underwent one-stage urethroplasty using different mucosal grafts between January 2003 and December 2014. The mean age was 48 years (range 38-72). The mean stricture length was 14.3±2.6 cm (range 11.0-22.0). Midline perineal incisions or circumcoronal and midline perineal incisions were used and two procedures were chosen as follow: ①the strictured urethras were dissected from the corpora cavernosa only along the left side and the stricture urethras were opened by a dorsal longitudinal incision which extended about 1.5 cm into the proximal healthy urethras. The strictured urethras were augmented using oral mucosal grafts(1.5 to 2.0 cm in width and an appropriate in length) (n=50); ② for the patients whose urethras were very narrow or obliterated, the urethras were reconstructed using colonic mucosal graft(3 cm in width and an appropriate in length)after the severe strictured urethras were excised (n=28). Biopsies were taken separately from the urethral meatus and bulbar urethral specimens. Results All of the 78 patients were followed up for 6-110 months (mean of 48.3 months). Sixty-nine patients (88.5%) urinated well, with the mean urinary peak flow rate of 23.4 ml/s (range 15.2-47.0 ml/s), and urethrography showed that each had a patent urethra with adequate lumen. Complications associated with urethra occurred in 9 patients (11.5%). Three patients developed urinary fistula secondary to infection, which required surgical correction; 6 patients developed meatal stenosis 3-11 months postoperatively, and all voided well after meatoplasty. The incidence of LS-positive biopsies was 100.0% in the glans and 88.5% in the meatus. In the bulbar urethral mucosa, the histological alteration in all biopsies was squamous metaplasia of the hyperplasia, and no histological evidence of typical LS was documented. However, homogenization of the collagen with diffuse lymphocyte infiltration was observed in the bulbar urethral specimens of 2 patients, and squamous metaplasia of the hyperplasia with serious orthokeratosis that was similar to its cutaneous counterpart was found in another 2 patients. Conclusions Our study suggests that urethroplasty with oral mucosal grafts is effective to treat panurethral stricture associated with LS. Urethroplasty with a colonic mucosal graft is suitable for repairing very severe strictured or obliterated urethra. No histological evidence of typical LS is observed in the bulbar urethral specimens. Key words: Urethral stricture; Lichen sclerosus; Colonic mucosa; Urethral reconstruction

The Surgical Learning Curve for One-stage Anterior Urethroplasty: A Prospective Single-surgeon Study

BackgroundThe learning process for one-stage anterior urethroplasty has never been addressed before. ObjectiveTo evaluate the surgical learning curve for one-stage anterior urethroplasty. Design, setting, and participantsData from 641 consecutive patients treated with one-stage urethroplasty for urethral stricture were collected prospectively. All the procedures were performed by a single surgeon between 1994 and 2014. InterventionOne-stage anterior urethroplasty using substitute tissues. Outcome measurements and statistical analysisThe outcome was treatment failure, defined as any postoperative instrumentation needed including dilation. Surgeon experience was coded as the total number of one-stage urethroplasties performed by the surgeon before the operation. Multivariable Cox regression analysis was used to evaluate the association between surgeon experience and treatment failure. Covariates consisted of age, body mass index, smoking history (no, yes, ex-smoker), diabetes history (no or yes), previous surgical treatments (no or yes), stricture length, and stricture site (bulbar, penile, panurethral). Results and limitationsOverall, 546 patients (85%) were treated with one-stage oral mucosa urethroplasty; penile skin or skin flap was used in 95 patients (15%). Median follow-up among patients who did not experience surgical failure was 69 mo (interquartile range: 35–118). The failure-free survival at 5 yr was 77% (95% confidence interval [CI], 74–81). At multivariable analysis, surgeon experience was significantly associated with a lower probability of treatment failure (hazard ratio per 20 procedures: 0.98; 95% CI, 0.97–0.99; p=0.008). The surgical learning curve appeared lengthened, without reaching a plateau even after 600 procedures. ConclusionsIn this single-surgeon analysis, surgical experience has a significant impact on the probability of treatment success for one-stage urethroplasty. Better results are achieved only after a long learning curve that may not be justifiable for late-career and low-volume surgeons. Patient summaryThe probability of surgical success after one-stage urethroplasty is importantly influenced by surgeon experience. Better results are achieved only after a very long learning process.

Experience with one-stage buccal mucosa graft urethroplasty

Experience with one-stage buccal mucosa graft urethroplasty

The Impact of Resident Involvement in Male One-stage Anterior Urethroplasties

To assess the effect of resident involvement in male anterior urethroplasties with regard to perioperative and postoperative outcomes using a large multi-institutional prospectively collected database. Relying on the American College of Surgeons National Surgical Quality Improvement Program Participant User Files (2005-2012), we extracted all entries with Current Procedural Terminology coding for male one-stage anterior urethroplasty in men (54,310). Cases with missing entries on resident involvement were excluded. Descriptive and logistic regression analyses were constructed to assess the impact of trainee involvement (attending only vs resident) on perioperative and postoperative outcomes. Prolonged operative time (pOT) was defined as operative time >75th percentile (>204minutes). A total of 235 one-stage urethroplasties were performed during the study period, for which resident involvement was available. Resident involvement was significantly associated with younger patient age (P= .011) and patients with a pre-existing diabetic condition (P= .047). In univariate analyses, the rate of pOT was significantly higher in the resident involvement group (P= .027). In multivariate models, resident involvement was an independent predictor of pOT (odds ratio, 2.4; 95% confidence interval, 1.3-9.7; P= .035). There were no differences in 30-day postoperative complications, length of hospital stay, or readmissions. Limitations of the study include inability to adjust for case complexity and type of reconstruction. Resident involvement is associated with pOT for anterior urethral strictures. However, it does not adversely affect complication rates or the length of hospital stay.

Buccal mucosa urethroplasty: a 10-year retrospective review of maxillofacial and urological outcomes.

Reconstruction of a urethral stricture poses a difficult surgical problem. Anastomotic repair remains the gold standard. Strictures longer than 2cm may require substitution urethroplasty. This is a retrospective review of all patients who underwent urethral reconstruction with an autologous free buccal mucosa graft at a Regional hospital between 1998 and 2009. Variables recorded included; demographics: patient gender/age; follow-up period. Urology: pre-operative diagnosis/aetiology; presenting complaint; previous urological surgery, pre-operative retrograde urethrogram, stricture length, graft size, operative time/blood loss, morbidity, complications. Maxillofacial: pre-/post-operative inter-incisal opening, patency of Stenson's parotid duct, ipsilateral parotid swelling, sensory nerve deficit. A total of eight male patients were included. Mean age was 33years. Two patients had one-stage dorsal onlay urethroplasty, and the remaining six had a two-stage BMG urethroplasty. All patients underwent a urethrogram 20days post-operatively, which demonstrated no leak, and a good caliber grafted urethra in all cases. A flexible cystoscopy scope was accommodated in all patients 8weeks post-operatively. Mean follow-up was 42months. At long-term follow-up, there was no evidence of stricture formation, and all patients were voiding well. There were no long-term intra-oral complications. This study suggests that anterior urethral strictures up to 6cm in length may be predictably and safely managed with buccal mucosal urethroplasty. The buccal mucosa is easy to harvest, and can be used successfully in one- and two-stage grafting procedures. The rate of complications, from both a urological and maxillofacial perspective, in the group of patients studied was low.

Outcomes of Dorsal and Ventral Buccal Graft Urethroplasty at a Tertiary Hospital in Uganda

Purpose. Although the use of buccal mucosa in substitution urethroplasty has been practiced for some years, it has not been free of controversy over which surgical technique is the most appropriate to use. There is paucity of data in Sub-Saharan Africa about its success; this study presents the outcomes of dorsal and ventral buccal graft urethroplasty at a sub-Saharan tertiary hospital. Methods. This is a prospective study in which buccal mucosa was used for ventral and dorsal grafts; followup was up to two years. All patients provided informed written consent for the procedures. Results. Seventy-two patients with bulbar urethral strictures underwent buccal graft one-stage urethroplasty. Mean age was 55 years; etiology of the strictures was postinflammatory due to urethritis from sexually transmitted infections 97% (70/72) and trauma 3% (2/72). Buccal mucosa grafts were harvested from the cheek using a two-team approach. Grafts were placed on the ventral and dorsal urethral surfaces in 32 and 40 cases, respectively; the success rate was 84 and 80%, respectively. Repeated urethroplasty was successfully done among 10% (7/72) and patients reported resolution of symptoms in the follow-up period. Conclusion. There was no difference between dorsal and ventral onlay buccal graft outcomes for bulbar urethral strictures. The success rate was 80 to 84%.

MP9-05 OUTCOME OF SINGLE-STAGE REPAIR OF URETHRAL STRICTURE FOLLOWING HYPOSPADIAS REPAIR

INTRODUCTION AND OBJECTIVES: Urethral stricture disease in patients who have undergone prior hypospadias repair in childhood presents a challenge. The integrity of the residual urethral plate and quality of the available penile skin must be carefully evaluated when deciding on the type of repair. We report our experience in treating select cases of short and long urethral strictures in this patient population with a one-stage technique. METHODS: One-stage urethroplasty was performed in 29 patients between 1993-2007. Group 1 patients (n1⁄414) underwent an island skin flap onlay and Group 2 patients (n1⁄415) underwent buccal mucosal graft onlay. All patients had relatively healthy, but often narrow urethral plate, and all repairs were waterproofed by either a generous Dartos or tunica vaginalis flap. Patients were followed-up at 3 months, 6 months, 2 years and 5 years. RESULTS: Patient age ranged from 10-29 years. Mean stricture length was 7.1 cm in Group 1 (3-10cm) and 7.5 cm in Group 2 (2-12 cm). A total of 19/29 patients (65.5%) had an associated urethrocutaneous fistula. Penile curvature was present in 4/14 patients (28.5%) in Group 1 and 5/15 patients in Group 2 (33.3%) and was addressed at the time of surgery. Postoperative complications occurred in 2 patients in Group 1 (14.2%) and 2 patients in Group 2 (13.3%). Urethral fistula occurred in one patient (7.1%) in Group 1 and one patient (6.6%) in Group 2. Re-stricture occurred in one patient (7.1%) in Group 1 and one patient (6.6%) in Group 2. In Group 1 the fistula was closed and the recurrent stricture was corrected by buccal mucosal graft onlay successfully. In Group 2 the patient who developed a urethral fistula declined closure and the patient with recurrent stricture elected to perform self-dilation. Follow up cystoscopy was performed at 6 months and 2 years in all patients and in 14 patients the follow up extended to 5 years. None of the patients complained of any symptoms suggestive of recurrent stricture. CONCLUSIONS: The management of urethral stricture disease after prior hypospadias repair is controversial. In patients with scarred urethral plate and BXO we prefer two-stage repair. For patients who have a healthy residual urethral plate, regardless of its width, one-stage onlay repair using island skin flap or buccal mucosal graft for either short or long urethral strictures after prior pediatric hypospadias repair are equally successful. The decision of either technique is based on the quality of the penile skin and surgeon’s preference.

Pseudospongioplasty Using Periurethral Vascularized Tissue to Support Ventral Buccal Mucosa Grafts in the Distal Urethra

For ventral buccal mucosa graft onlay during bulbar urethroplasty, spongioplasty with advancement and closure of the corpus spongiosum is ordinarily performed to stabilize the graft. In the pendulous and distal bulbar urethra the spongiosum is often too thin to allow complete graft coverage. We describe the results of what to our knowledge is a novel technique for ventral graft coverage using periurethral vascularized tissue. We compared these results to those of conventional spongioplasty. We retrospectively reviewed all urethroplasties performed by 2 surgeons at separate tertiary care facilities from July 2007 to July 2012. One-stage urethroplasties involving ventral buccal mucosa graft placement were selected for analysis. Conventional spongioplasty was performed when possible. When spongiosal tissue was inadequate for graft coverage, periurethral tissue flaps were mobilized bilaterally and sutured together in the midline as pseudospongioplasty to provide coverage. We compared the outcomes of the 2 techniques. Of 637 urethroplasties performed during the 5-year study period 102(16%) with a buccal mucosa graft onlay met study inclusion criteria. Pseudospongioplasty was performed in 46 of 102 cases (45%), predominantly in the pendulous urethra (34 of 46 or 74%), with success in 37 of 46 (80%) at a mean followup of 41 months. Conventional spongioplasty had a similar 84% success rate (47 of 56 cases) at a mean followup of 39 months (p = 0.645). For conventional spongioplasty mean stricture length was 4.7 cm compared to 5.8 cm for pseudospongioplasty (p = 0.028). Ventral buccal mucosa grafts can be applied reliably to various locations throughout the anterior urethra. For distal grafts, flaps of periurethral tissue provide a suitable host bed for revascularization with results equivalent tothose of conventional spongioplasty.

An unexpected course after simultaneous urethral repair and reimplantation of penile prosthesis in a patient with a urethral stricture.

We experienced the growth of urethral hair along the urethral stricture six years after simultaneous urethral repair and reimplantation of penile prosthesis (RPP) in a patient with a urethral stricture. We detected hair in the urethra with a stricture on the bulbous urethra. Further, we performed hair removal by using a pair of cystoscopic forceps and internal urethrotomy. Then, we performed RPP, and the patient voided well; the prosthesis worked very well and without any complications. One-stage urethroplasty with a pedicle island of the penile skin and RPP in a simultaneous stage may be an option for treating the long-segment urethral stricture in the penile prosthesis patient. However, we should pay attention to the urethral hair growth that can occur after urethral repair performed using a skin graft.

One‐Stage Urethroplasty for Urethral Strictures at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South Western Nigeria

Urethral stricture, a common urologic condition, is probably the most common cause of urinary retention in tropical Africa and a frequent cause of lower urinary tract symptoms worldwide. This study aimed at presenting our experience with one-stage urethroplasty at the Ladoke Akintola University of Technology Teaching Hospital Osogbo, Nigeria. All male patients who underwent one-stage urethroplasty between December 2005 and December 2011 were studied retrospectively. Details of their presentation and management were reviewed. A total of 50 patients aged 2-75 years (mean ± SD 44.2 ± 21.53 years) with a urethral stricture underwent one-stage urethroplasty. The modal age group was 61-75 years (26 %). In all, 27 (54 %) patients were >40 years. Strictures following previous urethritis were more common (29, 58 %) than those seen after trauma (21, 42 %). Strictures following trauma were more common in men ≤ 40 years (52.2 %), and 69 % of strictures in men >40 years were infective in origin. Altogether, 88 % of strictures were exclusively found in the anterior urethra. In all, 32 (64 %) patients had bacteriuria at presentation. Strictures ≥ 2 cm with extensive fibrosis were noted in 21 (42 %). Excision of scar tissue was done, followed by end-to-end anastomosis in 32 (64 %), penile pedicle flap in 16 (32 %), and buccal mucosal graft in 2 (4 %) of the patients. Wound infection was the most common complication. Overall, 76 % of patients achieved a urine flow rate of 15 ml/s and postvoid residual urine of ≤ 50 ml. One-stage urethroplasty offered satisfactory results in the study group. It is recommended for urethral reconstruction in men with urethral stricture.

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.