Pendulous Urethra Research Articles

Distal urethral carcinoma: Contemporary management with phallus preserving techniques

IntroductionPrimary urethral carcinoma is a rare clinical entity with an incidence of 1 case per million in the United Kingdom. Cancers of the distal urethra are most commonly of squamous subtype and often associated with Human Papilloma Virus infection. Penile preserving techniques are recommended in tumours of the pendulous urethra with a number of surgical approaches described. Herein, we describe the surgical management of 7 patients presenting with primary urethral carcinoma. MethodsSeven patients diagnosed with primary urethral carcinoma of the distal urethra were identified using a prospectively maintained penile cancer database at our institution from May 2017 to November 2020. ResultsThe mean age at presentation was 56.5 (33-80) years. Presenting symptoms included visible lesion, LUTS and a groin mass. Three patients had lesions located within the glanular urethra and had a distal urethrectomy and primary closure. Two patients with lesions extending proximal to the glanular urethra and into or beyond the fossa navicularis had a distal urethrectomy with a hypospadic neomeatus formation. One patient with tumour extending into the glans penis underwent distal urethrectomy and partial glansectomy with split thickness skin graft. A partial penectomy was performed for one patient with urethral tumour invading the corporal heads. Mean follow-up was 23.4 (±17.0) months. There have been no disease recurrences to date. ConclusionPenile preserving techniques are feasible in patients with tumours of the pendulous urethra and do not appear to compromise local control.

Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men

BackgroundSeveral treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the surgical outcomes. AimThe aim of this study was to analyze the surgical outcomes after treatment of urethral strictures and urethral fistulas following metoidioplasty. MethodsA multicenter retrospective cohort study was conducted with transmen treated for strictures and fistulas after metoidioplasty in 3 tertiary referral centers. OutcomesThe primary outcome was the recurrence-free rate after surgical treatment of urethral strictures and urethral fistulas over a time period of 3 years postoperatively. ResultsOf 96 transmen included in this study with a urethral complication, 44 (46%) experienced a urethral fistula, 31 (32%) a urethral stricture, and 21 (22%) both complications simultaneously. The recurrence-free rate for urethral strictures following endoscopic management (ie, urethral dilation or direct visual internal urethrotomy) was 61% after 1, 50% after 2, and 43% after 3 years, compared to 82% following open treatment options after 1, 2, and 3 years (P = .002). Open treatment options were Heineke-Mikulicz procedure (7/9, 78% success), excision and primary anastomosis (3/3, 100%), 2-stage without graft (9/9, 100%), pedicled flap urethroplasty (1/1, 100%), and buccal mucosa graft urethroplasty (2/4 [50%] single-stage, 1/1 [100%] 2-stage). The recurrence-free rate for small urethral fistulas located at the pendulous urethra was 79% after 1, and 72% after 2 and 3 years, compared to 45% after 1, and 41% after 2 and 3 years for large fistulas, generally located at the urethral anastomoses of the fixed urethra. Treatment options for urethral fistulas were fistulectomy (26/48, 54%), fistulectomy & (redo) colpectomy (7/11, 64%), buccal mucosa graft urethroplasty (1/1, 100%), and retubularization of the urethral plate (3/4, 75%). A colpectomy before or during reoperation of a urethral fistula at the proximal urethral anastomosis showed higher success rates compared to without a colpectomy (7/11 [64%] vs 2/13 [15%] respectively, P = .03). Clinical ImplicationsThis study provides insight in the treatment possibilities and corresponding outcomes of urethral complications following metoidioplasty in transmen. Strengths & LimitationsStrengths were the relatively large sample size and the overview of multiple treatment options available. Limitations were the heterogeneity of the cohort, underexposure of some surgical modalities, and absence of patient-reported outcomes. ConclusionOpen surgical techniques show better long-term outcomes in the management of urethral strictures compared to endoscopic options, and a colpectomy is beneficial before or during urethral fistula repair at the proximal urethral anastomosis.de Rooij FPW, Falcone M, Waterschoot M, et al. Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men. J Sex Med 2022;19:377–384.

Treatment of Urethral Strictures in Transmasculine Patients.

Background: Urethral strictures are a common complication after genital gender-affirming surgery (GGAS) in transmasculine patients. Studies that specifically focus on the management of urethral strictures are scarce. The aim of this systematic review is to collect all available evidence on the management of urethral strictures in transmasculine patients who underwent urethral lengthening. Methods: We performed a systematic review of the management of urethral strictures in transmasculine patients after phalloplasty or metoidioplasty (PROSPERO, CRD42021215811) with literature from PubMed, Embase, Web of Science and Cochrane. Preferred Reporting Items for Systematic reviews and Meta-Analysis-(PRISMA) guidelines were followed, and risk of bias was assessed for every individual study using the 5-criterion quality appraisal checklist. Results: Eight case series were included with a total of 179 transmasculine patients. Only one study discussed the management of urethral strictures after metoidioplasty. Urethral strictures were most often seen at the anastomosis between the fixed and pendulous urethra. For each stricture location, different techniques have been reported. All studies were at a high risk of bias. The current evidence is insufficient to favor one technique over another. Conclusions: Different techniques have been described for the different clinical scenarios of urethral stricture disease after GGAS. In the absence of comparative studies, however, it is impossible to advocate for one technique over another. This calls for additional research, ideally well-designed prospective randomized controlled trials (RCTs), focusing on both surgical and functional outcome parameters.

Management of Urethral Injury During Penile Prosthesis Surgery

There has been relatively little research into the management of intraoperative urethral injury during insertion of penile prostheses. In this review, we describe how such injuries can occur and the common management strategies. There are no randomized trials or level 1 evidence for managing such intraoperative urethral injury, and most literature are small retrospective series, expert opinions, or systematic reviews that combine small observational studies. Anatomical considerations, corporal fibrosis, and Peyronie’s disease present risk factors for urethral injury. Injuries can be classified by location at the distal urethra (meatus to fossa navicularis), mid-urethra (fossa navicularis through pendulous urethra), or proximal urethra (proximal penile urethra to distal bulbar urethra). There is no true consensus on what actions to take when a urethral injury does occur, and management is changing over time. While the traditional course has been to abort the procedure, some surgeons now choose to repair the defect and proceed with prosthesis implantation. Urethral injury is a rare but serious complication during penile prosthesis insertion. Management is heterogenous and is heavily dependent on the location of the injury and the preference and experience of the surgeon.

EDITORIAL COMMENT

Obliterative stricture disease of the pendulous urethra presents a unique technical challenge given the potential for iatrogenicpenile curvature if the scarred segment is completely excised. The authors of the manuscript “Excision and primary anastomosis reconstruction for traumatic stricture of the pendulous urethra,” should be commended for challenging the dictum that anastomotic repairs are contraindicated for penile urethra strictures. 1 Hagedorn J.C. Voelzke B.B. Patient selection for urethroplasty technique. Urol Clin N Am. 2017; 44: 27-37 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The authors hypothesized that for short strictures in the penile urethra, anastomotic repair would be a safe, feasible alternative to 1- or 2-stage substitution urethroplasty.

Buccal One-Stage Mucosal Graft Urethroplasty for Urethral Stricture. Results of 10 Years of Experience.

Aim: Representing our data regarding use of buccal mucosa for treatment of recurrent urethral stricture. Evaluating effectiveness of buccal graft for reconstruction of urethral segment both penile and bulbar urethra.
 Materials and methods: We repaired 95 urethral strictures with buccal mucosa grafts from 2004 to 2015. Mean patient age was 39 years. The etiology of stricture was unknown in 54% of cases in other cases ischemia, trauma, instrumentation was the reason. 96% had undergone previous urethrotomy or dilation. The buccal mucosa graft was harvested from lower lip mostly. Mean graft length was 3.8 cm. The graft was placed on the ventral and dorsal bulbar urethral surface in 61 and 34 cases, respectively. In pendulous urethra we routinely use the dorsal graft the Asopa inlay graft or Barbagli onlay graft. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean follow-up was 36 months (range 16 to 62).
 Results: We had a success rate of 77% with dorsal inlay or onlay flap for pendulous urethra inferior than ventral graft used for bulbar urethra which was 81% success rate.
 Conclusions: In our experience the placement of buccal mucosa grafts into the ventral or dorsal surface of the bulbar urethra showed an acceptable success rates 81% and 77% respectively. Longer times of follow up is need to see if the results deteriorated more.

Excision and Primary Anastomosis Reconstruction for Traumatic Strictures of the Pendulous Urethra

ObjectivesTo present a multi-institutional experience with functional and patient-reported outcomes among men undergoing excision and primary anastomosis (EPA) urethroplasty for pendulous urethral strictures. MethodsWe describe the technique and present our experience with EPA for focal penile strictures. Patients undergoing urethroplasty (2004-2017) at 2 tertiary referral centers were reviewed, of whom 14 (0.7%) underwent EPA of radiographically confirmed pendulous urethral strictures. Validated questionnaires were utilized to evaluate overall improvement (Patient Global Impression of Improvement), urinary bother (International Prostate Symptom Score), and sexual function (International Index of Erectile Function-5). Treatment success was defined as urethral patency without need for subsequent reconstruction. ResultsAmong 14 men undergoing penile EPA, 13/14 (93%) had durable treatment success over a median follow-up of 43 months. No patient reported penile curvature postoperatively. Stricture etiology in most cases was posttraumatic (12/14), of which 4 had a history of urethral disruption secondary to penile fracture and 8 iatrogenic trauma. Median age was 51 years (IQR 30-60) and stricture length 1.0 cm (IQR 1.0-1.4). Erectile function was normal in 8/14 patients preoperatively, and postoperative median International Index of Erectile Function was 21. Most men reported significant global improvement in condition (median Patient Global Impression of Improvement 2, IQR 1-3) and most had only mild urinary bother (median International Prostate Symptom Score 4, quality of life 1). The single treatment failure had a history of hypospadias with multiple prior urethral procedures. ConclusionFor men with short strictures of the pendulous urethra, EPA has a high success rate, without adverse sequelae such as erectile function or penile curvature.

Penile-preserving surgery for primary urothelial carcinoma of male urethra

Primary urethral carcinoma is a rare cancer, comprising <1% of all malignancies. The location of this lesion presents a certain dilemma of treatment between efficacy and quality of life. We report an 84-year-old male patient, with a history of chronic hepatitis C, hypertension, and transient ischemic accident, who presented with dysuria and acute urinary retention. The intravenous urography showed mild prostatic enlargement, but no stone or filling defect was noted in the upper urinary tract. On urethrocystoscopy, multiple papillary tumors were found at the pendulous urethra, and the pathology of biopsy confirmed urothelial carcinoma. The patient was admitted, and electroresection with fulguration of urethral tumors was performed owing to the patient's old age and poor performance status. Intraurethral and intravesical chemotherapy with mitomycin C was regularly given at the outpatient clinic. Recurrent urothelial carcinomas were noted twice in the first 2 years of follow up, and repeated transurethral resections were done. Unfortunately, liver cirrhosis with hepatocellular carcinoma was diagnosed last June, for which he received transcatheter arterial chemoembolization. No recurrence of urethral cancer has been found on semiannual cystoscopy in the past 3 years. Penile-preserving surgery is a reasonable surgical option for elderly primary urethral carcinoma patients with acceptable oncological outcome and good quality of life.

Massive Inguinoscrotal Hernia Associated with Acute Renal Failure Complicated Acute Pyelonephritis

We report a 50-year-old man was brought to our Emergency Department due to fever and dyspnea for 2 days. The patient had difficulty in walking and was bed-ridden in the past 5 days due to massive right inguinoscrotal hernia. He had difficulty in micturition in the past 2 days. He was febrile with a body temperature of 39.5°C, a blood pressure of 82/50 mmHg, a pulse rate of 122 beats/minute, and a respiratory rate of 22 breaths/min. Physical examination showed left-sided costovertebral angle knocking tenderness and a large right-sided irreducible inguinoscrotal hernia. Initial laboratory examination revealed abnormalities as follows : l0 eukocyte counts 28.8 × 10 [3] /μL; procalcitonin >200 ng/mL; blood urea nitrogen 77.7 mg/dL; and creatinine 10.6 mg/dL. Computed tomography (CT) of abdomen displayed a large right inguinal hernia containing small and large intestine with compression on junction of bulbous and pendulous urethra. Coronal view of CT reviewed swelling and fat stranding of left kidney which indicated acute pyelonephritis.

Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi.

We report a rare case of iliac vein compression syndrome caused by urethral calculus. A 71-year-old man had a history of urethral stenosis. He complained of bilateral leg edema and dysuria for 1 week. Physical examination revealed bilateral distention of the superficial epigastric veins, so obstruction of both common iliac veins or the inferior vena cava was suspected. Plain abdominal computed tomography showed a calculus in the pendulous urethra, distention of the bladder (as well as the right renal pelvis and ureter), and compression of the bilateral common iliac veins by the distended bladder. Iliac vein compression syndrome was diagnosed. Bilateral iliac vein compression due to bladder distention (secondary to neurogenic bladder, benign prostatic hyperplasia, or urethral calculus as in this case) is an infrequent cause of acute bilateral leg edema. Detecting distention of the superficial epigastric veins provides a clue for diagnosis of this syndrome.

Anterior Urethral Valve and Diverticulum in a Neonate with Urinary Tract Infection

Introduction:Anterior urethral valve (AUV) is a rare congenital anomaly that can cause obstructive uropathy. AUV can lead to variable urinary tract symptoms, and if left untreated, it can result in end-stage renal disease. AUV should be immediately evaluated and managed. Herein, we present a neonate with AUV and diverticulum, who was treated by cystoscopy. Case report:A 11-day-old boy was referred to the nephrology department for evaluation of urinary tract infection, which was developed 2 days prior to admission. Pregnancy and routine ultrasound (US) were normal, and urinalysis showed pyuria. Routine investigations included blood urea nitrogen, serum creatinine, electrolyte panel, urine analysis (UA), and urine culture (UC). Abdominal US examination displayed a normal bladder with normal kidneys. A voiding cystourethrogram (VCUG) showed an anterior urethra diverticulum with dilation of the proximal urethra and trabeculated bladder; however, no vesicoureteral reflux was observed. Finally, the patient underwent endoscopy. Discussion: AUV is a congenital mucosal fold, located distally to the membranous urethra. AUV can be located anywhere distal to the membranous urethra and is found in bulbar urethra (40%), penoscrotal junction (30%), pendulous urethra (30%), and occasionally in the fossa navicularis, respectively. The exact etiology of this disease is unclear. AUV with associated diverticulum is a rare congenital urethral anomaly that can lead to penile swelling, urethral obstruction, urinary retention, incontinence, nocturnal enuresis, bladder rupture, and end-stage renal disease. Depending on the severity of anatomical obstruction, this condition may present soon after birth or later during childhood. VCUG is the most important imaging technique for the evaluation of urethral abnormalities. Congenital AUV in children has a generally good prognosis, but may occasionally result in poor renal outcomes such as renal insufficiency, renal failure, and patient‘s death.

Urethroplasty for High Risk, Long Segment Urethral Strictures with Ventral Buccal Mucosa Graft and Gracilis Muscle Flap

Long segment urethral strictures with a compromised graft bed and poor vascular supply are unfit for standard repair and at high risk for recurrence. We assessed the success of urethral reconstruction in these patients with a ventral buccal mucosa graft and gracilis muscle flap. We retrospectively reviewed the records of 1,039 patients who underwent urethroplasty at Lahey Hospital and Medical Center between 1999 and 2014. We identified 20 patients who underwent urethroplasty with a ventral buccal mucosa graft and a gracilis muscle flap graft bed. Stricture recurrence was defined as the inability to pass a 16Fr cystoscope. Mean stricture length was 8.2 cm (range 3.5 to 15). Strictures were located in the posterior urethra with or without involvement of the bulbar urethra in 50% of cases, and in the bulbomembranous urethra in 35%, the bulbar urethra in 10% and the proximal pendulous urethra in 5%. Stricture etiology was radiation therapy in 45% of cases, followed by an idiopathic cause in 20%, trauma in 15%, prostatectomy in 10%, and hypospadias failure and transurethral surgery in 5% each. Nine patients (45%) were previously treated with urethroplasty and 3 (15%) previously underwent UroLume® stent placement. Urethral reconstruction was successful in 16 cases (80%) at a mean followup of 40 months. One of the patients in whom treatment failed had an ileal loop, 2 had a suprapubic tube and urethral dilatation had been done in 1. Mean time to recurrence was 10 months (range 2 to 17). Postoperatively 5 patients (25%) had incontinence requiring an artificial urinary sphincter. Urethroplasty for high risk, long segment urethral strictures can be successfully performed with a ventral buccal mucosa graft and a gracilis muscle flap, avoiding urinary diversion in most patients.

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.

Pendulous urethral stricture: peculiarities and relevance of longitudinal penile fascio-cutaneous flap reconstruction in poor resource community.

To describe peculiarities of pendulous urethral stricture in South Western Nigeria and how prevalent social and environmental factors have made longitudinal distal penile island flap the preferred option for reconstruction of pendulous urethral stricture in such a poor resource community. All patients presenting with stricture located in the pendulous urethra in 3 hospitals in south western Nigeria, over a 5 year period were interviewed and had urethral reconstruction using longitudinal distal penile fascio-cutaneous island flap under spinal anesthesia. Thirty four cases were treated by this method during this period. Complications were found in 4 patients (11.8%) which include urethrocutaneous fistula, penile skin necrosis and wound infection. All cases had satisfactory overall outcome. Longitudinal penile fascio-cutaneous flap remains a viable option for a single stage repair of urethral stricture especially in poor resource communities.

102 EXTRACELLULAR MATRIX VERSUS BUCCAL MUCOSA GRAFT IN URETHRAL STRICTURE REPAIR

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (II)1 Apr 2013102 EXTRACELLULAR MATRIX VERSUS BUCCAL MUCOSA GRAFT IN URETHRAL STRICTURE REPAIR David Koslov, Kyle Wood, Ilya Gorbachinksy, Christopher King, Ryan Terlecki, and Brandy Hood David KoslovDavid Koslov Winston Salem, NC More articles by this author , Kyle WoodKyle Wood Winston Salem, NC More articles by this author , Ilya GorbachinksyIlya Gorbachinksy Winston Salem, NC More articles by this author , Christopher KingChristopher King Winston Salem, NC More articles by this author , Ryan TerleckiRyan Terlecki Winston Salem, NC More articles by this author , and Brandy HoodBrandy Hood Winston Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1480AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral strictures can be a challenge to repair. Many are amenable to single stage repair, however longer and/or more complex strictures require multiple stage repairs. Buccal mucosa is a well established modality in bridging these distances and has become the standard of care in multiple stage repairs. Yet harvesting buccal mucosa, a limited resource, adds time and potential morbidity to this procedure. An alternative matrix that is commercially available and performs well clinically would be ideal. We report our experience with urethral repair comparing buccal mucosa graft and Acell®, an extracellular matrix (ECM), for urethroplasty. The objective of this study was to compare ECM and buccal mucosa rate of contraction and take in urethral stricture repair. METHODS This is a retrospective chart review of a single surgeon's experience with 3 patients undergoing the first stage of a multistage urethral repair using extracellular matrix only in one patient and both buccal mucosa and extracellular matrix in the remaining two. Comparison of buccal mucosa and ECM contraction rates towards midline and take were demonstrated by time lapse photography. RESULTS Strictures were primarily bulbar, with one extending to the pendulous urethra. Average age was 68.6 (low of 66 high of 73). In all patients, both extracellular matrix and buccal mucosa showed good take, with appropriate granulation. Over 3 months, the patient receiving ECM only showed equal contraction towards midline, with good granulation. Patient reports satisfaction with treatment. Over 5 months, patients receiving both ECM and buccal showed slightly more contraction in ECM versus buccal mucosa. Photo at original procedure demonstrated buccal graft occupying 34.6% of urethral plate, and 54.3% at 5 months. Contraction was decided through photograph analysis using the urethral midline as a marker. Percentage of total wound occupied by the respective tissue was calculated. CONCLUSIONS Here we demonstrate a novel use of Acell®, a commercially available extracellular matrix. Compared to the current standard of care for urethral reconstruction, Acell® shows similar take and rates of contraction. All patients demonstrated urethral patency at follow up. This use of ECM is promising when compared to the standard of care, and merits further investigation. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e41 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Koslov Winston Salem, NC More articles by this author Kyle Wood Winston Salem, NC More articles by this author Ilya Gorbachinksy Winston Salem, NC More articles by this author Christopher King Winston Salem, NC More articles by this author Ryan Terlecki Winston Salem, NC More articles by this author Brandy Hood Winston Salem, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Holmium laser fulguration of superficial urothelial carcinoma of the pendulous urethra

Urothelial carcinoma may occur anywhere in the urinary tract including the pendulous urethra. To prevent urethral stricture after resection and monopolor fulguration we describe the use of the holmium laser to fulgurate recurrent pTa UC from the urethra. The surgical approach was staged and provided excellent long term results for management of superficial UC.

尿道狭窄症に対する経尿道的内尿道切開術の有効性の検討

Direct vision internal urethrotomy (DVIU) has been considered to be a low invasive and widely used therapeutic modality for male urethral stricture. However, its efficacy is still controversial. We herein evaluated the efficacy of DVIU for male urethral stricture. Nineteen patients 27 to 78 years old (median age = 59) underwent DVIU for urethral strictures at our hospital were included in this study. Strictures were at bulbar urethra in 17 patients, membranous urethra in 1 patient, and pendulous urethra in 1 patient. The stricture lengths estimated on retrograde urethrography were less than 1 cm in 13 patients, 1-2 cm in 2 patients, and more than 2 cm in 4 patients. The etiology of stricture was straddle injury in 7 patients, post transurethral surgery in 7 patients, pelvic fracture in 1 patient, and unknown in 4 patients. The operation was done by cold knife incision using guidewire. The duration of postoperative urethral catheterization was 5 to 35 days (mean 12.8 days). Follow up duration ranged from 1 month to 139 months (mean 48.2 months). The definition of postoperative re-stricture was the confirmation of re-stricture on retrograde urethrography or deterioration of symptom. While no severe complication was observed, postoperative re-stricture was seen in 13 patients. Stricture-free rates at 3 months, 6 months, and 5 years after the first DVIU were 44.4%, 38.1%, 20.3% respectively. Although second DVIU was done for 7 patients with re-stricture, six patients resulted in failure. Stricture-free rates at 3 months, 6 months, and 5 years after the second DVIU were 42.2%, 28.6%, 14.3% respectively. Though the third DVIU was done for two of them, they were unable to void just immediately after the removal of urethral catheters. Stricture-free rate in stricture less than 1 cm was higher than that in 1 cm or longer, though it did not reach significant difference (p = 0.1813). The efficacy of DVIU is lesser than we expected. DVIU seems to be excessively applied to male urethral strictures and should not be performed for long and recurrent urethral stricture.

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 ...

Entero‐urethroplasty for the salvage of bulbo‐membranous stricture disease or trauma

To describe a salvage procedure for bulbo-membranous stricture disease or trauma. Over a 10-year period 11 patients with otherwise unsalvageable strictures of the bulbo-membranous urethra or defects after trauma were treated by interposition of a tailored intestinal flap. An intestinal flap, on average 8 cm in length, was harvested from the ileum, the stomach, the right colon or (preferably) the sigmoid colon, and tailored to a calibre of 26-30 F. It was then sutured between the stump of the prostate and the distal bulbar or proximal pendulous urethra either following the normal perineal route for the urethra or a more direct route through a trench cut in the superior pubic ramus. Three patients developed proximal anastomotic contractures requiring interval dilatation in one and revision in two. Two patients developed a stone in the gut segment one of which was removed traumatically causing irreparable damage to the neourethra. The results were otherwise satisfactory. For an otherwise unsalvageable bulbo-membranous stricture or defect, a tailored flap of intestine, preferably sigmoid colon, gives satisfactory results. Of the two potential routes for the neourethra, we have more experience with the normal route but the direct route has several advantages.

Upper transverse scrotal approach for muscle- and nerve-sparing urethral stricture repair

Open surgery on bulbar urethral strictures has become a widespread procedure. While there is inconsistency which procedure to perform at the bulbar region, there is consistency of the used incisional approach despite of several potential disadvantages. Therefore, to bypass disadvantages, we performed an upper transverse scrotal approach for stricture repair in the pendulous urethra and the distal bulbar urethra as previously reported for the placement of an artificial urinary sphincter. Thirteen patients (n = 13) with bulbar urethral stricture were operated by upper transverse scrotal incision approach. On five patients a free foreskin graft in dorsal onlay technique was performed. Eight patients obtained an end-to-end-anastomosis procedure. Pre- and postoperative uroflowmetry as well as retrograde urethrocystography were done. Pre- and postoperative residual postvoid urine were estimated by transabdominal ultrasound. The patients were followed-up for up to 12 months. After stricture repair, Qmax improved from mean 9.0 mL/s (SD +/- 3.2) preoperatively to mean 20.3 mL/s (SD +/- 3.1), postoperatively. Postvoid residual urine decreased from mean 90.0 mL (SD +/- 68.7) to mean 41.5 mL (SD +/- 16.1). All retrograde urethrocystographies showed regular reconstructed urethral conditions. The upper transverse scrotal incision may combine the advantages of a less traumatical approach with the excellent results of perineal approach.