Pan-anterior Urethral Stricture Research Articles

“Detubularised Non Augmented Urethroplasty”- A Promising Option for Pananterior Urethral Stricture: A Case Series

Pananterior urethral stricture involving the penile and bulbar urethra is a challenging urological condition in the Indian population. In India, Balanitis Xerotica Obliterans (BXO) or Lichen Sclerosus (LS) is the most common cause of pananterior urethral stricture. Various surgical techniques have been described in the literature for present condition, with varied outcomes. However, there is still a need for a simple and effective procedure to address this problem. Hereby, the authors present a case series that included five male patients with BXO and pananterior urethral stricture who underwent Detubularised Non Augmented (DNA) urethroplasty between January 2022 and December 2022. The median age of the patients was 45 years, with a mean stricture length of 13 cm. The median follow-up period was 11 months. During the procedure, a scroto-perineal incision was made, and the anterior urethra was ventrally cut open from the meatus to the junction of the stricturous and normal urethra. A right-sided Tunica Vaginalis (TV) flap was raised (left is left), and the cut-open anterior urethra was wrapped with the TV flap, creating a “controlled fistula” at the proximal end of the detubularised urethra. The average operative time was 1.5 hours. The success of the procedure was determined by a postoperative peak flow rate of 12 mL/sec or more, with no further need for urethral dilatation or direct vision internal urethrotomy. The procedure was successful in 4 out of 5 cases (80%). One patient developed a narrowed urethra during follow-up and required serial catheter upgradation for urethral dilatation. In conclusion, DNA urethroplasty was found to be a simple and effective treatment option for the notorious pananterior urethral stricture associated with BXO.

STUDY OF BUCCAL MUCOSA GRAFT URETHROPLASTY IN URETHRAL STRICTURES: A SINGLE CENTRE EXPERIENCE

Background/purpose: This study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, bulbar, penile and pan anterior urethral stricture. This is a prospective hospital-Methods: based study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from August 2017 to July 2021. The total number of involved patients was 50. The success rateResults: was found to be 92% (n=46), while 4 (8%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 40 (80%) and 2 (4%) patients, respectively. late complications occurred as follows 14 (28%) patients had UTI, 7 (14%) had wound infections, 7(14%) had changes in ejaculation, and decrease in intensity of orgasm, and 3 (6%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG). Conclusion: BMG urethroplasty is a versatile technique for all types of anterior urethral stricture with all types of aetiologies with good long term results even in a small scale private hospital.

Etiology and characteristics of pediatric urethral strictures in a developing country in the 21st century

Urethral stricture disease in children is not uncommon as assumed; however, most of the information about the etiology, features, and natural history of pediatric strictures is extrapolations from adult series as the literature on this common entity is sparse, and most of the studies are small series. The current etiology and clinical features of urethral stricture disease in the pediatric population in the developing world were determined. The data of children with urethral stricture disease, who had undergone treatment in the tertiary center from 2001 to 2017, were retrospectively analyzed. After excluding girls, the database was analyzed for clinical presentation, possible causes of stricture, site and number of strictures, and length of stricture and for previous interventions. Subanalysis was performed for stricture etiology by patient age, stricture length, site, previous treatments, and presentation with paraurethral abscess. A total of 195 boys with strictures were identified. The common causes of pediatric urethral stricture were traumatic (36.9%), iatrogenic (31.8%), and idiopathic (28.7%). The anterior urethra was the location of the stricture in 141 patients (72.3%). Iatrogenic causes (due to catheterization, hypospadias repair, and valve fulguration) accounted for the majority of anterior urethral strictures (61/141 or 43.2%). Younger children had a tendency to have an iatrogenic and idiopathic cause for strictures, whereas older children had a traumatic etiology; 18.6% of strictures in children younger than 10 years were secondary to trauma, whereas 44.9% of the strictures in patients older than 10 years were traumatic in origin. Trauma was the major cause of posterior urethral strictures (53/54 or 98.1%) and was always associated with pelvic fracture. Strictures due to lichen sclerosus or infectious cause were rare (5 patients or 2.6%). The length of strictures was longer in pan anterior urethral strictures (mean: 82.0mm) than that of those due to lichen sclerosus (mean: 42.5mm) and in patients who had undergone previous treatment (mean: 28.7mm). Iatrogenic causes such as catheterization and hypospadias repair account for the majority of anterior urethral stricture disease in the pediatric population, especially the younger age-group. However, as the child grows, there is a gradual preponderance of traumatic urethral strictures, including posterior urethral strictures.

Evaluation of Health-related Quality of Life, Voiding Pattern and Sexual Function in Patients with Status Stage 1 Urethroplasty for Pan Anterior Urethral Stricture Disease

Evaluation of Health-related Quality of Life, Voiding Pattern and Sexual Function in Patients with Status Stage 1 Urethroplasty for Pan Anterior Urethral Stricture Disease

Isolated Penile Gangrene with Penile Abscess with Pan Anterior Urethral Stricture – A Rare Case Report

Isolated Penile Gangrene with Penile Abscess with Pan Anterior Urethral Stricture – A Rare Case Report

Holmium laser vs. conventional (cold knife) direct visual internal urethrotomy for short-segment bulbar urethral stricture: Outcome analysis.

Our goal was to analyze the outcome between holmium laser and cold knife direct visual internal urethrotomy (DVIU) for short-segment bulbar urethral stricture. We conducted a prospective study comprised of 112 male patients seen from June 2013 to December 2014. Inclusion criterion was short-segment bulbar urethral stricture (≤1.5cm). Exclusion criteria were prior intervention/urethroplasty, pan-anterior urethral strictures, posterior stenosis, urinary tract infection, and those who lost to followup. Patients were divided into two groups; Group A (n=58) included cold knife DVIU and group B (n=54) included holmium laser endourethrotomy patients. Patient followup included uroflowmetry at postoperative Day 3, as well as at three months and six months. Baseline demographics were comparable in both groups. A total of 107 patients met the inclusion criteria and five patients were excluded due to inadequate followup. Mean stricture length was 1.31 ± 0.252 cm (p=0.53) and 1.34 ± 0.251 cm in Groups A and B, respectively. Mean operating time in Group A was 16.3 ± 1.78 min and in Group B was 20.96 ± 2.23 min (p=0.0001). Five patients in Group A had bleeding after the procedure that was managed conservatively by applying perineal compression. Three patients in Group B had fluid extravasation postoperatively. Qmax (ml/s) was found to be statistically insignificant between the two groups at all followups. Both holmium laser and cold knife urethrotomy are safe and equally effective in treating short-segment bulbar urethral strictures in terms of outcome and complication rate. However, holmium laser requires more expertise and is a costly alternative.

Urethral Balloon Dilatation: Factors Affecting Outcomes

Background/Aims/Objectives: The study aims to review our experience with balloon dilatation of urethral strictures and retrospectively analyze predictors of improved success rates. Methods: One hundred and forty-four cases were analyzed from January 2011 to December 2012. Patients underwent balloon dilatation using 6-Fr Balloon dilator set (Cook Urological, Spencer, Ind., USA). Patients analyzed with respect to demography, uroflowmetry (Qmax) and need for auxiliary procedures in the immediate postoperative period, at 6 months and at 1 year. Comparisons were made between those who performed self-calibration against those who did not. Results: Overall success rate of balloon dilatation in our study was 84.4%. Procedural failure was observed with 3 patients (2.1%). Auxiliary procedure was required in 21 cases (15.6%) during follow-up. The mean Qmax (ml/s) in those who regularly performed self-calibration (n = 73) and in those who did not perform self-calibration (n = 39) in the immediate postoperative period, at 6 months and at 1 year were 24.2 ± 10.5, 16.5 ± 7.5, 14.4 ± 6.3 and 21.2 ± 10.6, 14.5 ± 7, 10.8 ± 5.6, respectively. Statistical significance was noted at 1 year (p = 0.003). Lesser re-treatments were required in those who performed self-calibration (12.3 vs. 20.5%). Improved success rates were noted with focal and bulbar strictures. Iatrogenic strictures and pan-anterior urethral strictures had poor outcomes despite self-calibration. Conclusions: Balloon dilation with self-calibration significantly improves flow rates at 1 year and lessens auxiliary procedures required. It is simple, easy to perform under local anesthesia and repeatable in case of re-strictures.

Penile Circular Fasciocutaneous (McAninch) Flap as an Option for Complex Anterior Urethral Stricture in Case of Non-Viable Buccal Mucosal Graft

The penile circular fasciocutaneous flap (FCF) is employed in the successful single stage reconstruction of long segment complex anterior urethral strictures especially when buccal mucosa is unavailable due to various reasons. A 65-year-old gentleman, chronic smoker and tobacco chewer, hypertensive on treatment, presented with obstructive lower urinary tract symptoms for 8 months. He had no prior urethral catheterization. On examination, he had circumcised penis, with stenosis of the external urethral meatus. Glans had no changes suggesting balanitis xerotica obliterans. Suprapubic cystostomy was done as he developed acute urinary retention during evaluation. Retrograde urethrogram (RGU) showed pan-anterior urethral stricture. He was planned for substitution urethroplasty. On oral cavity examination, he had moderate trismus with oral submucous fibrosis. As buccal mucosal graft was unavailable, he was planned for FCF. A ventral onlay tubularization FCF urethroplasty from meatus to bulbar urethra based on dartos dorsal pedicle was done. His postoperative recovery was uneventful. Pericatheter RGU did not show extravastion and he voided well with Qmax 14 ml/second. He is doing well at follow-up.

MP13-02 COMPARATIVE STUDY BETWEEN THE USE OF MODIFIED ANNULAR PENILE FLAP AND CIRCULAR ISLAND PENILE FLAP FOR REPAIR OF PAN-ANTERIOR URETHRAL STRICTURE.

You have accessJournal of UrologyUrethra: Benign & Malignant Disease1 Apr 2014MP13-02 COMPARATIVE STUDY BETWEEN THE USE OF MODIFIED ANNULAR PENILE FLAP AND CIRCULAR ISLAND PENILE FLAP FOR REPAIR OF PAN-ANTERIOR URETHRAL STRICTURE. Mohmad Zakieldahshoury, Wael Gamal, and Elniser Rashed Mohmad ZakieldahshouryMohmad Zakieldahshoury More articles by this author , Wael GamalWael Gamal More articles by this author , and Elniser RashedElniser Rashed More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.671AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to determine which is better to use for long pan-anterior urethral stricture, the circular island penile flap or the modified annular (zigzag) penile flap. METHODS 60 male patients were diagnosed as long pan-anterior urethral stricture. Their age ranged from 20-65ys old. All patients were complaining of obstructive, irritative voiding symptoms and some with genitourinary complications. The mean length of stricture was 18cm (15-20). Urine flow rate was 9±2ml/sec in all patients. Group (A) repaired with Zigzag penile flap & group (B) repaired with circular penile flap. Follow up was after one month, three months& one year by AUG, VCUG, flow rate & may be urethroscopy when indicated. RESULTS Success was achieved in 55 patients from those who were treated with penile annular flap and modified annular penile flap. Flow rate was improved to 15.5ml/sec. 2 patiens had short stricture proximally at the anastomotic site < 0.5cm, which were treated with VIU after 3 months then passed smooth with no further complications. 2 pateints developed long stricture segment which was reoperated after 3 months. One patient developed coronal fistula that had repaired after 3 months with simple closure. Some minor complications as chorde in one patient and post voiding drippling in two patients were accepted by the patients. CONCLUSIONS Meticulously fashioned Zigzag annular penile flap adds more length than circular penile flap with no need for additional techniques to repair long pan-anterior urethral stricture. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e176 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mohmad Zakieldahshoury More articles by this author Wael Gamal More articles by this author Elniser Rashed More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

793 Management of pananterior urethral strictures due to LS/BXO by single stage dorsal buccal onlay urethroplasty

793 Management of pananterior urethral strictures due to LS/BXO by single stage dorsal buccal onlay urethroplasty

Analysis of short-term results of monsieur′s tunica albuginea urethroplasty as a definitive procedure for pan-anterior urethral stricture

Context:Long anterior urethral strictures are fairly common in developing world and the treatment is equally challenging.Aim:To assess the results and efficacy of Monsieur's Tunica Albuginea Urethroplasty (TAU) for anterior urethral stricture.Settings and Design:We analyzed the results in 10 consecutive patients with pan-anterior urethral stricture, who underwent Monsieur's urethroplasty.Materials and Methods:The procedure involves mobilization of strictured urethra and laying it open with a dorsal slit. Edges of the slit-open urethra are sutured to edges of the urethral groove to the tunica of corporal bodies with catheter in situ. Results were assessed postoperatively 3, 6, 9 and 12 months. Patients were categorized as success and failure by comparative analysis of patient satisfaction along with urethroscopy, retrograde urethrogram, uroflowmetry. All patients were taken for post-operative urethroscopic analysis at 6 months to allow better understanding of both successful and failed cases.Results:Mean follow-up of 15.2 (11-19) months showed an 80% success rate. Mean uroflow rate showed Qmax 24.5 cc/sec with 8 cases showing no residual or recurrent stricture. Two cases failed and required intervention. Urethroscopic visualization of the reconstruction site showed wide, patent and distensible neourethra appearing epithelized over roof formed by tunica albuginea of the corpora cavernosa in successful cases.Conclusion:Monsieur's TAU is effective technique in treatment of anterior urethral stricture especially cases with unavailable buccal mucosa, with results fairly acceptable at the end of one year.

Management of Panurethral Stricture Disease in India

Panurethral stricture involving the penile and bulbar urethra is a common urological problem on the South Asian subcontinent. It represents a particularly difficult challenge to manage and there is a relative paucity of literature on the subject. In India lichen sclerosus is the most common etiology of panurethral stricture, followed by iatrogenic causes. We present our experience with panurethral stricture repair using 1-stage, 1-side dissection dorsal onlay repair with oral mucosa grafts. We retrospectively reviewed the records of 117 consecutive men who underwent treatment for panurethral stricture from June 1998 to December 2010. Median patient age was 47.8 years, mean stricture length was 14 cm and median followup was 59 months. The stricture was approached through a perineal incision, limiting dissection to only 1 side of the urethra. The penis was invaginated to provide access to the entire length of anterior urethra in 1 stage. Two oral mucosal grafts were placed dorsally. The outcome was considered a success if the patient required no further instrumentation, including dilation or urethrotomy. The overall success rate was 83.7% with a success rate of 86.5% for primary urethroplasty and 61.5% in patients in whom urethroplasty had previously failed. Most recurrent strictures developed at the proximal end of the graft. Repair of panurethral stricture in 1 stage with 1-side dissection and dorsal onlay of oral mucosa graft is a minimally invasive technique that is simple, fast, safe, effective and reproducible by any surgeon.

Hybrid Minimally Invasive Urethroplasty for Pan-Anterior Urethral Strictures: Initial Results

Introduction: To describe our minimally invasive hybrid technique for treating pan-anterior urethral stricture. Patients and Methods: From February 2009 through November 2011, 12 patients with pan-anterior urethral stricture were operated on in our unit. The bulbospongiosus muscle was mobilized on one side, and a 2.5-cm dorsolateral bulbar urethrotomy was made. A full-thickness cold knife optical internal urethrotomy was made to reach the corpus cavernosum as graft bed. A 14- to 16-cm-long, 15- to 16-mm-wide buccal/lingual mucosa graft was harvested and sutured dorsally at the site of urethrotomy, and then distally at the meatus along with meatoplasty. Results: The mean operating time was 91.66 min. The average hospital stay was 2.4 days. The Foley catheter was removed after 3 weeks. The mean Q_max preoperatively and postoperatively was 5.5 ± 1.87 and 18.83 ± 2.04 ml/s, respectively. Our mean follow-up was 18.5 ± 6.92 (6–32) months. Conclusions: Our hybrid technique provides good short-term results while promoting minimal urethral mobilization and graft vascularity.

VID-03.07 Hybrid Minimally Invasive Oral Mucosal graft Urethroplasty for Pan-Anterior Urethral Strictures

VID-03.07 Hybrid Minimally Invasive Oral Mucosal graft Urethroplasty for Pan-Anterior Urethral Strictures

840 SINGLE-STAGE DORSAL ONLAY BUCCAL MUCOSA GRAFT URETHROPLASTY FOR COMPLEX (PENDULOUS AND PAN-UREHTRAL) STRICTURES

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011840 SINGLE-STAGE DORSAL ONLAY BUCCAL MUCOSA GRAFT URETHROPLASTY FOR COMPLEX (PENDULOUS AND PAN-UREHTRAL) STRICTURES Anand Sehgal and Harpreet Jolly Anand SehgalAnand Sehgal Ludhiana, India More articles by this author and Harpreet JollyHarpreet Jolly Ludhiana, India More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.660AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Buccal mucosa graft (BMG) is considered the tissue of choice for single stage reconstruction of the bulbar urethral strictures but its use for pendulous and pan-anterior urethral strictures has not been reported widely. This study was done to assess the outcome of single-stage dorsal onlay BMG urethroplasty for pendulous and pan-urethral strictures in terms of voiding function, erectile function and morbidity of oral cavity. METHODS A total of 44 patients underwent dorsal onlay buccal mucosa graft urehtroplasty from October 2006 to March 2010 out of which 21 were complex strictures involving pendulous urethra only (6), segments of both pendulous and bulbar urethra (6) and pan-urethral strictures (9). Age of the patients ranged from 30 to 67 (mean=51.8) years. Mean graft length was 9.5 cm (range, 6-16 cm). Etiology of the stricture was instrumentation (9), balanitis xerotica obliterans (5) and idiopathic (7). Ten patients underwent OIU and 4 patients had got suprapubic cystostomy done prior to surgery. Buccal mucosa graft site was left unsutured in all cases after securing hemostasis. All procedures were done through perineal incision. Recurrence rates, need for further procedures, erectile dysfunction and complications were analysed retrospectively. RESULTS Eighteen (85.7%) patients were stricture free at a mean follow up of 33.4 (range, 8–48) months. All 3 (14.3) recurrences presented within first 7 months of the procedure, 2 were panurethral strictures out of which one required meatal dilatation and other required OIU. One pendulous urethral stricture also required OIU. Two patients (both panurethral) complained of significant chordee. No patient complained of deterioration of erectile function after the procedure however 1 noted improvement in sexual activity. Four (19%) patients continued to have graft site numbness even after 6 months. No patient complained of difficulty in mouth opening. CONCLUSIONS Pendulous and panurethral strictures can be reconstructed satisfactorily by single stage dorsal onlay buccal BMG urethroplasty with acceptable complication rates. Leaving graft site unsutured causes minimal post-operative morbidity. Possibility of chordee (in patients with pan-urethral strictures) and numbness of oral mucosa should be explained to the patients before the procedure. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e337-e338 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anand Sehgal Ludhiana, India More articles by this author Harpreet Jolly Ludhiana, India More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Anesthetic management in a patient with Kindler′s syndrome

A 35-year-old male with pan-anterior urethral stricture was scheduled to undergo perineal urethrostomy. He was a known case of Kindler's syndrome since infancy. He was having a history of blister formation, extensive poikiloderma and progressive cutaneous atrophy since childhood. He had a tendency of trauma-induced blisters with clear or hemorrhagic contents that healed with scarring. The fingers were sclerodermiform with dystrophic nails and inability to completely clench the fist. Airway examination revealed thyromental distance of 7 cm with limited neck extension, limited mouth opening and mallampatti class III with a fixed large tongue. He was reported as grade IV Cormack and Lehane laryngoscopic on previous anesthesia exposure. We described the anesthetic management of such case on guidelines for epidermolysis bullosa. In the operating room, an 18-G cannula was secured in the right upper limb using Coban™ Wrap. The T-piece of the cannula was than inserted into the slit and the tape was wrapped around the extremity. The ECG electrodes were placed on the limbs and fixed with Coban™. Noninvasive blood pressure cuff was applied over the wrap after wrapping the arm with Webril® cotton. Oral fiberoptic tracheal intubation was done after lubricating the laryngoscope generously with a water-based lubricant with 7-mm endotracheal tube. Surgery proceeded without any complication. After reversing the residual neuromuscular block, trachea was extubated once the patient became awake. He was kept in the postanesthesia care unit for 2 hours and then shifted to urology ward.

Modified annular penile skin flap for repair of pan-anterior urethral stricture

Journal of Men's HealthVol. 6, No. 3 WCMH AbstractsModified annular penile skin flap for repair of pan-anterior urethral stricture11Mohmad EldahshouryMohmad EldahshourySearch for more papers by this authorPublished Online:21 Nov 2013https://doi.org/10.1016/j.jomh.2009.08.013AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Modified annular penile skin flap for repair of pan-anterior urethral stricture." Journal of Men's Health, 6(3), p. 231FiguresReferencesRelatedDetails Volume 6Issue 3Sep 2009 InformationWPMH GmbHTo cite this article:Mohmad Eldahshoury.Modified annular penile skin flap for repair of pan-anterior urethral stricture.Journal of Men's Health.Sep 2009.231-231.http://doi.org/10.1016/j.jomh.2009.08.013Published in Volume: 6 Issue 3: November 21, 2013PDF download

Modified annular penile skin flap for repair of pan-anterior urethral stricture

To review our experience with a zigzag shape annular penile fasciocutaneous flap (modified McAninch flap) for reconstruction of pan-anterior urethral strictures. From 2003 to 2006, 30 male patients with pan-anterior urethral stricture were repaired by single-stage urethroplasty using a modification of the annular penile flap of McAninch for augmentation of a long anterior urethral stricture (zigzag annular penile fasciocutaneous flap). The procedure was total bulbopenile urethral mobilization, stricturotomy, and ventrally positioned zigzag annular penile island fasciocutaneous flap. Age of patients ranged from 20-60 years. Range of stricture length was 15-20 cm. All strictures were bulbopenile post inflammatory or post catheter with exclusion of BXO in all cases by clinical picture and pre-operative biopsy. Follow up period was 24 months. Urethral patency was documented clinically, urodynamically, by RUG, and by urethroscopy for 26 male patients for whom repair was performed by use of this technique. Re-stricture occurred in four patients, fistula in one patient, and post voiding dripping in two patients. A meticulously fashioned zigzag annular penile skin flap could be raised to bridge a urethral defect up to 20 cm long and has the advantage of one-stage repair. No additional grafts are needed. Cosmetic outcome included a straight penis in all cases.