Panurethral Strictures Research Articles

The Management of Panurethral Strictures – The Kulkarni Technique

The Management of Panurethral Strictures – The Kulkarni Technique

Current Trends in the Use of Buccal Grafts During Urethroplasty Among Society of Genitourinary Reconstructive Surgeons

ObjectivesTo analyze current standards in urethroplasty by urologists employing buccal mucosal grafts (BMG) for treating urethral stricture disease (USD). MethodsAn IRB-approved online survey was distributed to members of the Society of Genitourinary Reconstructive Surgeons (GURS) between July and October 2022 to assess BMG utilization in urethroplasty. Questions covered surgeon experience, graft harvest site, graft length, surgical technique, and perceived success rates. ResultsOf 350 invited GURS members, 134 responded (38%). 69% were GURS fellowship-trained, performing 10-30 urethroplasties annually. 95% harvested their own grafts, with 99% preferring buccal mucosa as the primary site. Buccal mucosa was favored over fasciocutaneous flap for penile urethroplasty, regardless of circumcision status (95% with, 84% without). For bulbar urethroplasty with BMG, dorsal graft placement was favored (66%) over ventral (34%). Most surgeons (90%) preferred multiple BMGs over combined graft/flap for panurethral strictures. When harvesting long grafts, 56% preferred using both cheeks. Anastomotic urethroplasty was preferred over buccal graft urethroplasty for short bulbomembranous stenosis post-radiotherapy (63% vs. 37%). Surgeons reported a success rate of 80-90% (53%). ConclusionsThe expanded scope of reconstructive urology has led to increased use of BMG in diverse urethral reconstructions. Buccal grafts are now preferred for penile, bulbar, and panurethral strictures, demonstrating high perceived success rates in the reconstructive community.

Three Optilume® drug-coated balloon dilations in series for panurethral stricture disease

Three Optilume® drug-coated balloon dilations in series for panurethral stricture disease

Novel single-stage preputial spiral graft for panurethral stricture: a step-by-step description of the technique.

To report the 12-month results of a novel urethroplasty technique relying on a spiral preputial graft for panurethral stricture disease. Twenty consecutive patients were treated between May and October 2021 at our center. A spiral preputial mucocutaneous graft is a foreskin-based graft, developed from a 5-cm-wide preputial skin, which is harvested using a helicoidal shape and can reach up to 20cm in length. Stricture characteristics were assessed through preoperative retrograde and voiding cystourethrogram and maximum uroflowmetry data (Qmax). Complications were collected up to 30days after surgery and graded using the Clavien-Dindo (C-D) classification. The patients were followed up to 12months. Preoperative median Qmax was 6.5ml/s [interquartile range (IQR): 4.0-8.7]. After a median follow-up of 12months (IQR 12-13), six patients experienced at least one complication. Of them, two patients had grade 2 C-D complications, while only one developed a grade 3a C-D complication. The median postoperative Qmax was 16ml/s (IQR: 13-18). Only one patient had early urethral stricture recurrence treated with dilatation after catheter removal. At one-year follow-up, no other patients had urethral stricture recurrence with an overall median Qmax of 15.1ml/s (IQR 13.5-16.4). Our novel single-stage spiral preputial graft urethroplasty for panurethral stricture treatment appears to be safe and could be used as a valid alternative to two-stage procedures or even to single-stage buccal mucosa graft augmentation.

PD35-12 MULTI-INSTITUTIONAL ANALYSIS OF SURGERY FOR LICHEN SCLEROSUS INDUCED PENILE URETHRAL STRICTURES: CONFIRMING SINGLE-STAGE URETHROPLASTY AS THE TREATMENT STANDARD

You have accessJournal of UrologyCME1 Apr 2023PD35-12 MULTI-INSTITUTIONAL ANALYSIS OF SURGERY FOR LICHEN SCLEROSUS INDUCED PENILE URETHRAL STRICTURES: CONFIRMING SINGLE-STAGE URETHROPLASTY AS THE TREATMENT STANDARD Ross Hengel, Alex Vanni, Bradley A Erickson, Sean Elliott, Benjamin Breyer, Jill C Buckley, Joshua Broghammer, Bryan Voelzke, Jeremy B Myers, Nathan Hoy, and Keith Rourke Ross HengelRoss Hengel More articles by this author , Alex VanniAlex Vanni More articles by this author , Bradley A EricksonBradley A Erickson More articles by this author , Sean ElliottSean Elliott More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Jill C BuckleyJill C Buckley More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Jeremy B MyersJeremy B Myers More articles by this author , Nathan HoyNathan Hoy More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal treatment of penile urethral strictures related to lichen sclerosus (LS) is controversial. At the heart of the debate lies the issue of whether or not a single-stage reconstruction should be employed over a 2-stage repair to minimize the number of surgeries performed. Additionally, depending on patient preference, a urethrostomy is a viable option. The objective of this study is to compare single-stage urethroplasty, staged urethroplasty and perineal urethrostomy for the treatment of LS related penile urethral strictures in a multi-institutional analysis. METHODS: A retrospective analysis was performed on patients undergoing urethroplasty for LS induced isolated penile urethral strictures (LSE S2b/S2c) at 9 different institutions. Meatal strictures <2 cm in length and panurethral strictures (>10 cm) involving the bulbar urethra were excluded from study. Patients were reconstructed using either a single-stage approach, a staged technique or perineal urethrostomy. The primary outcome measure was urethral patency at routine follow-up cystoscopy without stricture intervention thereafter and secondary outcomes were 90-day complications, and adverse change in sexual dysfunction, chordee or urethrocutaneous fistula. Outcomes were compared using a Cox regression or a two-tailed Chi-square test when appropriate. RESULTS: 231 patients were analyzed with an average age of 51.6 years and mean stricture length of 5.5 cm. Prior endoscopic treatments were performed in 197 patients (85.3%) with a mean of 3.0 prior endoscopic treatment attempts. Overall, 127 (55.0%) were managed with single-stage BMG urethroplasty, 44 (19.0%) with staged BMG, and 60 (26.0%) with perineal urethrostomy. At a mean follow-up of 68.6 months, overall stricture free rate was 81.0% (n=187). Clavien ≥2 90-day complications occurred in 17 patients (9.8%). de novo erectile dysfunction occurred in 13 patients (5.6%), chordee in 7 (4.8%), and urethrocutaneous fistula in 3 (3.4%). On Mantel-Cox testing, there was no difference in stricture recurrence between techniques (15.7% vs. 27.3% vs. 20.0%; p=0.60) and no difference in 90-day complications (8.0% vs. 15.6% vs. 9.8%; p=0.45), erectile dysfunction (7.1% vs. 4.5% vs. 3.3%; p=0.55), chordee (6.7% vs. 0.0% vs. 3.6%; p=0.33), and urethrocutaneous fistula (2.2% vs. 9.1% vs. 0.0%; p=0. 0.17). On Cox regression analysis, obesity (BMI>35) was associated with a higher rate of stricture recurrence (Hazard Ratio 2.31, 95%CI 1.28-4.17, p=0.006, 30.1% vs. 13.9%) but not 90-day complications (Odds Ratio 1.00, 95% CI 0.33-2.99, p=0.99, 9.8% vs. 9.8%). No other clinical variable was associated with stricture recurrence or 90-day complications. CONCLUSIONS: Favorable outcomes of single-stage techniques for the treatment of lichen sclerosus induced penile urethral strictures, confirm single-stage urethroplasty as the treatment standard for LS induced penile urethral strictures especially when considering the decreased number of surgeries the patient is exposed to. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e979 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ross Hengel More articles by this author Alex Vanni More articles by this author Bradley A Erickson More articles by this author Sean Elliott More articles by this author Benjamin Breyer More articles by this author Jill C Buckley More articles by this author Joshua Broghammer More articles by this author Bryan Voelzke More articles by this author Jeremy B Myers More articles by this author Nathan Hoy More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...

Analysis of prognostic factors of failure in perineal urethrostomy.

To identify prognostic factors of failure in patients undergoing perineal urethrostomy (PU) with Blandy technique, with inverted U-shaped perineal flap. This is a retrospective study of PU of non-oncological causes (2001-2017). Data of age, BMI, history of diabetes mellitus, etiology of urethral stricture, type of stricture, previous surgeries, dilatation and suprapubic catheter were collected. Failure was defined as the need for any instrumentation after surgery. Variables were analyzed by Cox regression and Kaplan-Meier curves were used for survival analysis. A total of 115 PU were performed. Median age was 61years (IQR 53-68) and BMI 27.9 (IQR 25-30.9). The most frequent etiologies were: lichen sclerosus (30.4%), iatrogenic (27%), and idiopathic (25.7%). 62.6% had panurethral stricture. There were no complications in 73%. Clavien I complications occurred in 25.2%, Clavien II in 0.9% and Clavien IVa in 0.9%. The overall success rate was 51.3% with a median follow-up of 71months. In the last 8years, it was 75%. In the multivariate analysis, we found that age (p = 0.01), BMI (p = 0.01), date of surgery (p = 0.01), and suprapubic catheter (p = 0.003) were predictive variables. The voiding satisfaction rate was 88.7%. PU with Blandy technique is a surgery with low morbidity. During the entire study period, it had a failure rate of 48.7% but the failure rate decreased to 25% over the last 8years. Age, BMI, date of surgery and suprapubic catheter are the most important prognostic factor of failure.

Redo panurethral stricture: A challenge in reconstructive urology

Redo panurethral stricture: A challenge in reconstructive urology

Prospective Assessment of Genital Pain in Patients With Urethral Stricture: Incidence, Associations, and Impact of Urethroplasty

To assess the incidence of genital pain in patients with urethral stricture and examine the impact of urethroplasty. Genital pain is a common and challenging urological condition and potentially associated with urethral stricture. From 2011-2019, patients were offered enrollment in a prospective single-center study assessing patient-reported genital pain pre- and 6-months posturethroplasty. Genital pain was assessed with the question, "Do you experience genital (scrotum or penis) pain?" answered on a five-point scale ["Never" (1), "Occasionally" (2), "Sometimes" (3), "Most of the Time" (4) or "All of the Time" (5)]. Responses of 3, 4, or 5 were considered clinically significant. Wilcoxon signed-rank test was used to compare pre- and postoperative states and logistic regression was used to evaluate the association between genital pain and clinical variables. Of the 387 patients completing enrollment, 36.4% (141/387) reported genital pain preoperatively. Patients with panurethral stricture reported higher rates (57.1%) of pain (Odds Ratio 2.93, 95%CI 1.32-6.50; P=.008). Posturethroplasty, pain scores improved with an incidence of 14.2% (P < .0001). In patients reporting preoperative pain, 88.7% (125/141) experienced improvement, 8.5% were unchanged and 2.8% reported worsening pain. On logistic regression, patients with penile strictures (O.R. 0.24, 95%CI 0.06-0.91; P=.04), hypospadias (O.R. 0.14, 95%CI 0.02-0.88; P=.04), and staged reconstruction (O.R. 0.22, 95%CI 0.05-0.90; P=.04) were less likely to report improvement. Genital pain is common in patients with urethral stricture and improves in the majority of patients undergoing urethroplasty but less so in patients with penile strictures, hypospadias and staged reconstruction.

Single-Port Endorobotic Rectal Mucosa Harvest For Urethral Reconstruction.

Colorectal mucosal grafts for substitution urethroplasty are alternatives for patients when buccal mucosa is not adequate for long urethral strictures. This study presents the first cases of single-port endorobotic rectal mucosa harvesting for urethral reconstruction. The patients are 43- and 57-year-old men with medical histories of lichen sclerosis. The urethrograms demonstrated panurethral strictures requiring long mucosal grafts. The single-port robot was docked under general anesthesia in the modified lithotomy position. The procedure began with a submucosal injection of a lifting agent. After achieving an adequate lift of the mucosa, the dissection was started 2 cm proximal to the sphincter complex with a hook and continued cephalad. The semiflexible robotic platform eased and facilitated the dissection providing the required traction and counter traction. The injecting needle and aspiration device were directed with the help of a silk knot at the tip of the tools to create a handle for robot arms. The procedure was continued with a spatula tip thinner than the hook, which delivers less energy to the dissection field and creates a precise cut. The harvested graft was provided to the urology team after pinning it for measurement. The urologists prepared and completed the reconstruction of the urethra with the autograft. The patient had no complications related to his rectal mucosa harvest. We report the first 2 cases of single-port robotic rectal mucosal harvesting for long panurethral strictures with single-port endorobotic submucosal dissection technique. The technique seems promising to facilitate the precise submucosal dissection with meticulous control of traction and delivered energy.

906 Schistosomiasis: The New ‘Gap Year’ Problem

Abstract Introduction Schistosomiasis is endemic in Africa, Asia, and South America. The parasite, found in freshwater lakes, ultimately deposits eggs in the veins around organs including the bladder. It causes chronic inflammation resulting in fibrosis of the urogenital tract and malignancy. In the UK, cases of schistosomiasis are unusual and historically confined to the immigrant population. The patient We present the case of a British born 21-year-old who returned from a round-the-world gap year. Upon return he reported dysuria, abdominal pain, poor flow, and malaise. He was investigated for tropical diseases, treated for recurrent urine infections, and sexually transmitted infections before disclosing on direct questioning to swimming in Malawi. Cystoscopy demonstrated tight pan-urethral strictures. Sandy patches were seen throughout the bladder. Histology from bladder biopsy confirmed schistosomiasis eggs. The patient was treated with Praziquantel. Despite treatment he will likely require repeat urethral dilatations. Discussion Changes in travel practice has led to a shift in patients who present with schistosomiasis. Clinicians should consider the diagnosis in anyone with lower urinary tract symptoms who has visited Asia, Africa, or South America. In those diagnosed, clinicians have a duty to encourage them to urge fellow swimmers to seek urological input. Similarly travel-clinics should be encouraged to warn travellers against fresh-water swimming prior to travel. To avoid long term schistosomiasis sequelae, prevention is preferable, but early and prompt intervention is the next best alternative. Clinicians need a low threshold to suspect and exclude this damaging diagnosis.

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

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

Перинеальная уретростомия: результаты, клинико-статистические и терминологические аспекты

The analysis of the results of perineal urethrostomy for urethral stricture in men for the period from 2000 to 2020 is presented in the article. We identified 29 original articles devoted to this technique, including 4 Russian and 25 foreign publications. In two studies, there were more than 100 patients, four studies included from 51 to 77 men, and in remaining studies less than 50 patients were analyzed. Complete data on all pre- and postoperative aspects of perineal urethrostomy were provided only in a few studies. In the overwhelm of cases, perineal urethrostomy was performed after one or several unsuccessful reconstructive procedures and only in few patients it was done prior to various types of urethroplasty. It was not possible to establish any association between etiological factors and localization of urethral stricture among these patients. The incidence of pan-urethral stricture ranged from 28.6% to 100%. Only in one study the average stricture length was 2 cm, while in all other studies it was 5 cm or more. Postoperative follow-up was on average 14 to 62 months. Treatment success with perineal urethrostomy ranged from 0% to 100%, but in most studies it was 75% or more. The most common perineal urethrostomy technique used included Blandy technique, and Johanson and 7-flap techniques.

Single-Port, Robot-Assisted Transanal Harvest of Rectal Mucosa Grafts for Substitution Urethroplasty

ObjectiveTo describe a novel single-port, endorobotic technique for harvesting rectal mucosa grafts (RMGs) for urethral reconstruction. MethodsA 57-year-old man with prior transurethral procedures developed recurrent obstructive voiding symptoms. Urethrography revealed a panurethral stricture, meatus to the bulbomembranous junction. It was decided to proceed with surgical repair. Owing to the stricture's length, available oral mucosa would require additional material, and repair with a single rectal mucosa graft was offered instead. Single-port (SP) endorobotic approach offered ideal access for transanal harvest. With the patient placed in a modified lithotomy position, a GELPOINT Path transanal access platform was inserted through the anal canal. Pneumorectum was established at 12 mmHg with an AirSeal CO2 insufflator. A Da Vinci SP surgical system was docked, equipped with Maryland bipolar forceps and a monopolar spatula. After injection of ORISE gel, endorobotic submucosal dissection began posteriorly proximal to the dentate line. ResultsProceeding cranially through the rectal submucosa, a 21 ✕ 3 cm strip of mucosa was obtained with appropriate hemostasis. The resulting graft was thoroughly thinned. The robot was undocked, and the patient repositioned to high lithotomy. The patient underwent a penis-inverting, dorsolateral approach augmentation urethroplasty. With an indwelling catheter placed, the patient was discharged on postoperative day 2 with no postoperative complications. ConclusionTransanal rectal mucosal dissection with a single-port endorobotic approach can be an enticing and minimally invasive harvesting technique to provide substitution grafts for long-segment urethral reconstruction.

V04-04 NEW SURGICAL TECHNIQUE: A SINGLE LONG SPIRAL PREPUTIAL GRAFT FOR PANURETHRAL STRICTURE

You have accessJournal of UrologyCME1 May 2022V04-04 NEW SURGICAL TECHNIQUE: A SINGLE LONG SPIRAL PREPUTIAL GRAFT FOR PANURETHRAL STRICTURE Pankaj Joshi, Marco Bandini, Shreyas Bhadranawar, Vipin Sharma, Sandeep Bafna, and Sanjay Kulkarni Pankaj JoshiPankaj Joshi More articles by this author , Marco BandiniMarco Bandini More articles by this author , Shreyas BhadranawarShreyas Bhadranawar More articles by this author , Vipin SharmaVipin Sharma More articles by this author , Sandeep BafnaSandeep Bafna More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002560.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of panurethral stricture is challenging. Etiology is usually either Lichen Sclerosus or Iatrogenic. Single stage dorsal onlay with Kulkarni Technique is a preferred approach. In lichen sclerosus, local genital skin cannot be used. We describe a new spiral preputial graft dorsal onlay single stage Urethroplasty for non LS Panurethral strictures. METHODS: Ours is a tertiary care referral center for urethroplasty with experience of more than 6000 Urethroplasties in last 2 decades. This is a prospective study from Jan 2020-July 2021.9 patients of Panurethral stricture were included. None of them had LS. Stricture length was 14 cm. Urethrogram was performed prior to Urethroplasty. Perineal incision, penile invagination, dorsal onlay approach was performed. A outer circumcision incision was made just deep to the skin. The prepuce was harvested with dissection above the dartos. This was continued to the inner prepuce. Inner circumcision incision was made. The prepuce was harvested like a cylinder. The prepuce was then slided over a 20 cc disposable syringe. A spiral incision was made and a long continuous 1.5 cm wide and 20 cm long graft was made. This was described by Anderson et el. This graft was applied as dorsal onlay like Kulkarni technique from meatus till proximal bulbar urethra. Catheter was removed after 4 weeks. RESULTS: At follow up, all the patient passed urine within normal uroflow. At 6 months follow up, uroflow remained excellent with a Qmax of 22.3ml/sec. 1 patient had proximal narrowingThere was no chordee, urinary tract infections or sexual dysfunction. There were no local complications. CONCLUSIONS: BMG Urethroplasty is the preferred augmentation material for strictures. The results of Penile skin and BMG are almost comparable. In Asian subcontinent, many men have an intact prepuce. By harvesting a spiral long graft, we avoid junctional strictures (which can take place at the site of 2 BMG). The graft is long and there is no need to harvest another graft. There is no oral morbidity. We also preserve the preputial dartos, which preserves the neurovascular supply. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e367 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj Joshi More articles by this author Marco Bandini More articles by this author Shreyas Bhadranawar More articles by this author Vipin Sharma More articles by this author Sandeep Bafna More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

PD31-09 PROSPECTIVE ASSESSMENT OF GENITAL PAIN IN PATIENTS UNDERGOING URETHROPLASTY: INCIDENCE, ASSOCIATIONS AND IMPACT OF SURGERY

You have accessJournal of UrologyCME1 May 2022PD31-09 PROSPECTIVE ASSESSMENT OF GENITAL PAIN IN PATIENTS UNDERGOING URETHROPLASTY: INCIDENCE, ASSOCIATIONS AND IMPACT OF SURGERY Declan Rourke, Jordan Bekkema, and Keith Rourke Declan RourkeDeclan Rourke More articles by this author , Jordan BekkemaJordan Bekkema More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002582.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Genital pain is an exceedingly common urological condition with a probable but unclear association with urethral stricture. The objective of this prospective study is to assess the incidence of genital pain in patients with urethral stricture and examine the impact of urethroplasty. METHODS: Over a 7-year period (2011-2018), patients were offered enrollment in a prospective single-centre study assessing patient-reported genital pain pre- and 6-months post-urethroplasty. Genital pain was assessed with the question, “Do you experience genital (scrotal or penis) pain?” answered on a five-point scale [“Never” (1), “Occasionally” (2), “Sometimes” (3), “Most of the Time” (4) or “All of the Time” (5)]. Responses of 3, 4, or 5 were considered clinically significant. Descriptive statistics were used to summarize findings, Wilcoxon signed-rank test was used to compare pre- and post-operative states and logistic regression was used to evaluate the association between genital pain and clinical variables. RESULTS: 387 patients completed enrollment with a mean age of 49.5 years and stricture length of 4.5cm. Pre-operatively, 36.4% (141/387) of patients reported genital pain with overall responses of 5.7% “all of the time”, 9.8% “most of the time”, 20.9% “sometimes”, 29.7% “occasionally” and 33.9% “never”. Patients with panurethral stricture reported significantly higher rates (57.1%) of pre-operative pain (Odds Ratio 2.93, 95%CI 1.32-6.50; p=0.008) while others factors were not (including age (p=0.07), stricture length (p=0.08), etiology (p=0.43), number of endoscopic treatments (p=0.52), and prior urethroplasty (p=0.42)). Overall, pain scores improved post-urethroplasty (p<0.0001) with responses of 1.0% “all of the time”, 3.6% “most of the time”, 9.6% “sometimes”, 21.2% “occasionally”, and 64.6% “never”. Specifically, in those reporting pre-operative genital pain, 88.7% (125/141) experienced improvement (p<0.0001), 8.5% were unchanged and 2.8% reported worse pain. On logistic regression analysis patients with penile strictures (O.R. 0.24, 95%CI 0.06-0.91; p=0.04), hypospadias (O.R. 0.14, 95%CI 0.02-0.88; p=0.04), and staged reconstruction (O.R. 0.22, 95%CI 0.05-0.90; p=0.04) were less likely to report improvement in genital pain (80.0%, 76.5% and 69.2% respectively). No identifiable clinical factor was associated with worsening pain. In the entire study cohort, 50.4% reported improvement in genital pain after urethroplasty, 37.0% were unchanged and 12.7% reported worsening pain. In the overall cohort, patients undergoing staged reconstruction were again less likely to report an improvement in genital pain status (O.R. 0.49, 95%CI 0.26-0.95; p=0.04) with no factor associated with worsening of genital pain post-urethroplasty. CONCLUSIONS: Genital pain is common in patients presenting with urethral stricture and more common in those with panurethral stricture. While the exact mechanism remains to be determined, genital pain improves in the majority of patients undergoing urethroplasty but less so in patients with penile strictures, hypospadias and staged reconstruction. Source of Funding: Northern Alberta Urology Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e544 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Declan Rourke More articles by this author Jordan Bekkema More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF DownloadLoading ...

V16 - New surgical technique: A single long spiral preputial graft for panurethral stricture

V16 - New surgical technique: A single long spiral preputial graft for panurethral stricture

Clinical Study of Single Stage Dorsolateral Onlay Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

1.1. Objectives: To evaluate the results of dorsolateral onlay buccal mucosal graft (BMG) urethroplasty in various types of long segment anterior urethral stricture. 1.2. Materials and Methods: This is a prospective study, conducted in the Department of Urology, Medical College, Kolkata and Burdwan Medical College, Burdwan from April 2017 to March 2021. Forty patients with long segment (more than 1.5 cm) anterior urethral stricture who underwent substitution urethroplasty using dorsolateral onlay BMG urethroplasty were evaluated with detailed history, physical examination, ultrasonography of KUB with PVRU, uroflowmetry, retrograde urethrography and voiding cystourethrography, sono-urethrograms and cystoscopy. After treatment with dorsolateral onlay BMG urethroplasty, they were followed-up with uroflowmetry at 3 monthly interval for one year and RGU and/or urethroscopy if indicated. Success was defined as normal voiding pattern without any intervention post-operatively. 1.3. Results: With nineteen of the forty cases (47.5%), lichen sclerosus formed the single most common etiology. Panurethral strictures were more common. Out of total 40 cases, 33 (82.5%) had successful outcome and 7 (17.5%) were failure. 1.4. Conclusion: We conclude that it is a simple, technically feasible, easily adoptable and finally successful procedure

Prospective study of de novo sexual dysfunction after anterior urethroplasty: Causative factors, incidence, and recovery of function - A single-center experience.

Objectives:The objectives of this study were to evaluate the effect of single-stage anterior urethroplasty on sexual function by considering age, stricture length, location, and different surgical techniques. Incidence of postoperative sexual dysfunction (SD) and probability of recovery were also highlighted.Materials and Methods:A total of 115 patients undergoing anterior urethroplasty from February 2016 to June 2020 were evaluated prospectively. Patients were categorized on the basis of age, location, length of stricture as well as surgical techniques. We evaluated three domains of sexual function (erectile, orgasmic, and overall satisfaction) using the International Index of Erectile Function (IIEF) preoperatively and then after 3 months and 6 months postoperatively in follow-up. Pre- and postoperative IIEF values were compared.Results:The mean age was 41.7 ± 13.9 years. There was a significant decrease in postoperative IIEF score from the preoperative value in older patients (>40 years) along with poor recovery at the 6th month as compared to patients of younger age group (≤40 years). However, there was a significant reduction of sexual function postoperatively in case of longer stricture segment, panurethral stricture, bulbar urethral stricture, dorsal buccal mucosal urethroplasty, and excision-primary anastomosis technique in univariate analysis, but on multivariate analysis, only age was proved to be an independent predictor of de novo SD which was found in a total of 28 patients (24.3%).Conclusion:Overall, anterior urethroplasty does not influence postoperative sexual function, whereas only older patients have a poor outcome. Most of the younger patients recover completely by 6 months.

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.

PD22-08 STAGED SPLIT-THICKNESS SKIN GRAFT URETHROPLASTY FOR COMPLEX URETHRAL STRICTURES: LONG-TERM FOLLOW-UP AND PATIENT-REPORTED OUTCOMES

INTRODUCTION AND OBJECTIVE:There are only few reconstructive options in men with recurrent, panurethral strictures, and diversion, perineostomy or suprapubic catheter are frequently inevitable. We ...