Recurrent Urethral Stricture Research Articles

Efficacy of direct visual internal urethrotomy versus balloon dilation to treat recurrent urethral stricture following failed urethroplasty

Efficacy of direct visual internal urethrotomy versus balloon dilation to treat recurrent urethral stricture following failed urethroplasty

Predictors of urethral stricture recurrence following internal urethrotomy: A systematic review.

To estimate the factors associated with urethral stricture recurrence in patients undergoing internal urethrotomy by direct vision. A systematic review was performed in MEDLINE (Ovid), EMBASE, LILACS, and central databases. Clinical, quasi-experimental, cohort, case-control, and cross-sectional trials were included. The search strategy found 402 studies, and 6 were finally included. All of them were clinical trials. A total of 1723 patients diagnosed with urethral stricture undergoing internal urethrotomy were included. The primary associated factor was the association between the length of stricture and recurrence. Other factors described were post-RTU as etiology, previous interventions for urethral stricture management, and previous Qmax on uroflowmetry less than 5 ml/s. The length of urethral stricture was identified as the leading association with stricture recurrence following internal urethrotomy. Other associated factors were post-URT as etiology, previous interventions for managing stricture, and Qmax less than 5 ml/s. However, studies with better methodology are required.

Intralesional injection of mitomycin C following visual internal urethrotomy for recurrent urethral stricture: a randomized controlled study.

To assess the efficacy of Intralesional injection of mitomycin C (MMC) following visual internal urethrotomy (VIU) in the management of recurrent urethral stricture. Fifty male patients diagnosed with recurrent single bulbar urethral stricture measuring less than 1.5 cm previously treated with VIU were randomly allocated into two equal groups, (Group A) planned for VIU only and (Group B) planned for VIU with intralesional MMC injection using Botox injection needle. All patients were objectively evaluated pre- and post-operatively at 3, 6, and 12 months using uroflowmetry, post-void residual urine volume, and retrograde urethrography. Forty-five patients completed their follow-up in our study. Patients who underwent intralesional MMC injection showed significant improvement in uroflowmetry, post-voiding residual, and with a success rate (82.6% in Group B, compared to 50% in Group A with a highly statistically significant difference, p-value: <0.001). VIU with MMC was the only factor associated with a marked decrease in stricture recurrence (p = 0.02) as shown in the Multivariate Cox regression analysis. Intralesional injection of mitomycin C seems to be a safe and effective modality in reducing the recurrent stricture rate after VIU.

Feasibility, efficacy, and safety of retrograde intrarenal surgery in &lt;1-year age group: A single-center experience

Purpose: Urolithiasis in infants is uncommon. Percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and retrograde intrarenal surgery (RIRS) are the management options. RIRS is the least studied of these options in infants. In our series of 23 cases, we aim to assess the feasibility, efficacy, and safety of RIRS in &lt;1-year age group. Materials and Methods: This was a retrospective analysis of a series of 23 infants who underwent RIRS in our hospital from January 2018 to March 2021. Children who were &lt;12 months of age and had the largest stone size of &lt;20 mm were included in the study. Results: Twenty-three patients (male – 15; female – 8) were included in the study. The mean age was 10 ± 2.31 months (range, 4–12 months). The mean stone size was 11.6 ± 2.96 mm (range, 7.5–19 mm). The mean operative time was 29.44 ± 7.45 min (range, 17–42 min). Six patients (22.2%) had mild hematuria (Clavien I), and seven patients (25.9%) had postoperative fever. Stone size had a significant positive correlation with laser time, operative time, and intraoperative intravasation, but no significant association with stone-free rate. At 2-month follow-up, 4 (three patients) out of 27 renal units had residual stones (stone-free rate [SFR] – 85.1%). No patient had long-term complications like urethral or ureteric stricture or stone recurrence during the given follow-up period. Conclusion: RIRS is a feasible and minimally invasive treatment for renal stones in infants with acceptable SFRs.

From failure to success: management of recurrent urethral strictures with buccal mucosa graft

From failure to success: management of recurrent urethral strictures with buccal mucosa graft

The use of amniotic membrane injection as an adjunct in endoscopic urethral stricture management

ABSTRACT Introduction: Endoscopic urethral stricture treatment has high recurrence rates. Due to research supporting amniotic membrane’s (AMs) anti-inflammatory and anti-fibrotic properties reducing scar tissue formation, AM has generated interest in reconstructive urethral surgery. To the best of our knowledge, we performed the first investigation of the success rate of urethral dilation when combined with micronized AM injection for the treatment of urethral stricture. Methods: Eligible patients were adult males with anterior strictures meeting strict criteria for diameter, length, International Prostate Symptom Score (IPSS), and flow rate. Micronized AM was injected in the stricture region during urethral dilation. The primary study endpoint was an anatomical success (≥14Fr) at 6 months. Secondary endpoints were evaluated with the IPSS, urethral stricture surgery – patient-related outcome measure, International Index of Erectile Function, flow rate, and postvoid residual. Outcomes were assessed at baseline and multiple points postinjection. Injection safety was analyzed. Results: Ten men with a mean age of 52 years were included in the study. At 6 months, 7 of 10 patients demonstrated recurrence of the urethral stricture on cystoscopy. Improvements in secondary endpoints were noted in 10 of 10 patients at 3 months and 3 of 10 patients at 6 months. No adverse events were observed. Conclusions: To the best of our knowledge, this is the first study evaluating micronized AM injection as an adjunct treatment at the time of urethral dilation. The urethral stricture recurrence rate did not improve with the injection of AM despite the hypothesized benefits of anti-fibrotic and anti-inflammatory properties.

Применение большого количества методов оперативного лечения стриктуры уретры у одного пациента: клинический случай

Introduction. Insufficient surgical experience and inadequate choice of surgical treatment options may be the reasons for the failure of treatment of urethral stricture. In this regard, a clinical case from our practice is very indicative. Case: The article is devoted to the description of a clinical case of urethral injury in a man who, at the age of 22 years, suffered a fracture of the pelvic bones as a result of a traffic accident. From the moment of injury to the final operation, the following types of surgical interventions were sequentially performed in this patient: anastomotic endto-end urethroplasty, augmentation urethroplasty using a skin graft, augmentation urethroplasty using a graft of the tunica vaginalis of the testicle, bougienage of the urethra, urethroplasty with a vascularized radial fasciocutaneous flap on a vascular pedicle, 2-stage urethroplasty using a graft of the buccal mucosa according to the type of Bracka I and II operations, perineal urethrostomy. Urethrostomy became the final option for urine diversion; no recurrence of urethral stricture was observed during 4 years of follow-up after urethrostomy. Conclusion. Until recently, the lack of uniform approaches to the treatment of urethral stricture has led to the use of inadequate methods of surgical treatment in various clinics. The recent approval of federal clinical guidelines for urethral stricture should help optimize the treatment of this disease. Keywords: urethral stricture, urethroplasty, urethrostomy

A single-institution experience with the Optilume Urethral Drug Coated Balloon for management of urethral stricture disease.

Urethral stricture disease is detrimental to quality of life. The Optilume Urethral Drug Coated Balloon (DCB) offers a solution utilizing a paclitaxel-coated balloon to expand strictures and prevent recurrence. Following the ROBUST trials, it has been proposed that DCB is more effective than conventional endoscopic management for recurrent, small anterior urethral strictures. Our study provides insights into practical applications and outcomes using DCB for urethral stricture disease. A retrospective review was performed of patients who underwent DCB for urethral strictures at our institution from November 2022 to August 2023 with follow-up evaluated through January 2024. Demographics, stricture characteristics, operative details, and postoperative outcomes were collected. Primary endpoint was need for repeat intervention as determined by symptomatic burden and subsequently postoperative post-void residual if obtained. Secondary endpoint was complication rate. Statistical analysis was conducted using STATA/BE17.0 software to create Kaplan-Meier curves for time to repeat intervention after treatment with DCB. Of 43 patients, 16 had no prior treatment. The other 27 had endoscopic treatment and of this group, 11 also had additional urethroplasty. Stricture etiologies included 20 iatrogenic, 14 idiopathic, 5 radiation-related, 2 inflammatory, and 2 traumatic. Stricture locations were 2 fossa navicularis, 7 pendulous, 17 bulbar, 7 membranous, 3 prostatic, and 7 bladder neck contractures. Mean balloon dilation lasted 8.4±2.7 minutes. All patients had a minimum follow-up of 150 days postoperatively and the mean duration of follow-up for the cohort was 290.3±87.0 days. The average postoperative post-void residual was 33.4±90.6 milliliters. Two patients had immediate complications: 1 with urinary retention after catheter removal requiring suprapubic tube placement and 1 with urinary tract infection requiring antibiotics. Four patients required repeat interventions: 1 endoscopic dilation, 1 graft urethroplasty, and 2 repeat DCB procedures. Mean time to repeat intervention was 203.5±82.6 days, and no patient required repeat intervention within 145 days of initial surgery. DCB offers a safe and less invasive treatment for both treatment-naïve and recurrent urethral strictures with paclitaxel coating to prevent recurrence. Repeat intervention was not required for 90.7% of our cohort within an average follow-up duration of 9 months postoperatively. As DCB grows in clinical use, investigation into its long-term efficacy is justified.

The Impact of Social Deprivation on Anterior Urethral Stricture Recurrence After Urethroplasty: A Trauma and Urologic Reconstructive Network of Surgeons Analysis.

Several factors influence recurrence after urethral stricture repair. The impact of socioeconomic factors on stricture recurrence after urethroplasty is poorly understood. This study aims to assess the impact that social deprivation, an area-level measure of disadvantage, has on urethral stricture recurrence after urethroplasty. We performed a retrospective review of patients undergoing urethral reconstruction by surgeons participating in a collaborative research group. Home zip code was used to calculate Social Deprivation Indices (SDIs, 0-100), which quantify the level of disadvantage across several sociodemographic domains collected in the American Community Survey. Patients without zip code data were excluded from the analysis. The Cox proportional hazards model was used to study the association between SDI and the hazard of functional recurrence, adjusting for stricture characteristics as well as age and BMI. Median age was 46.0 years with a median follow-up of 367 days for the 1452 men included in the study. Patients in the fourth SDI quartile (worst social deprivation) were more likely to be active smokers with traumatic and infectious strictures compared to the first SDI quartile. Patients in the fourth SDI quartile had 1.64 times the unadjusted hazard of functional stricture recurrence vs patients in the first SDI quartile (95% CI 1.04-2.59). Compared to anastomotic ± excision, substitution-only repair had 1.90 times the unadjusted hazard of recurrence. The adjusted hazard of recurrence was 1.08 per 10-point increase in SDI (95% CI 1.01-1.15, P = .027). Patient social deprivation identifies those at higher risk for functional recurrence after anterior urethral stricture repair, offering an opportunity for preoperative counseling and postoperative surveillance. Addressing these social determinants of health can potentially improve outcomes in reconstructive surgery.

Ventral Onlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: Medium-term Results in a Single Surgeon Experience

ObjectiveTo describe our own approach using buccal mucosal grafting and to assess the outcome of this approach. Materials and MethodsA total of 42 patients underwent ventral onlay BMG by a single surgeon between 2017 and 2022. A longitudinal incision along the length of the urethra was made through the anterior vaginal wall and the peri-urethral fascia was incised to create two flaps. This ventral urethrotomy ran from the meatus into the proximal health urethra above the level of the stricture.A buccal mucosal graft was harvested and sutured to the margins of the urethral mucosa itself and the flaps of peri-urethral fascia. The vaginal wall was then closed. ResultsThe mean age of the patients was 53.6 ± 12.8 years. There were no perioperative or postoperative complications. At a mean follow-up of 38.1 months, 41 patients (98%) were stricture-free. Peak flow rate improved from a mean of 7.7 ± 3.2 ml/s preoperatively to 25.9 ± 5.9 ml/s postoperatively. No patient developed incontinence. One patient developed a recurrent urethral stricture which was treated by redo urethroplasty. ConclusionsThe surgical technique applied has proved efficiency. The ventral BMG preserves the urethral sphincter and so avoids postoperative incontinence. The use of peri-urethral fascia represents a good vascular and mechanical support for the graft.

Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy?

IntroductionInternal urethrotomy (IU) has been the most commonly used procedure for the treatment of urethral strictures (US) since it was described by Scahse in 1974. Although simple to perform and associated with a short recovery time, the main disadvantage is the high recurrence rate of stenosis. At present, there are no markers available for the prediction of recurrence after IU. The aim of this study was to evaluate the correlation between MHR and recurrence rates. MethodsThe data of a total of 250 male patients who underwent IU for the first time for bulbar urethral stricture less than 2cm in our hospital between January 2011 and January 2019 were retrospectively analysed. The MHR was calculated as the ratio of monocytes to HDL-C. ResultsIn all, 78 patients experienced a recurrence while the remaining 177 did not. The stricture recurrence rate was recorded as 31.2% at the 3-year follow-up. There was a statistically significant difference in stricture length and MHR (P=0.015 and 0.001 respectively). MHR was high in the recurrent group. As a result of the Chi-square test, the positive predictive values (PPV) and negative predictive values (NPV) were 65.3% and 89.7%, respectively. ROC analysis was used to determine the optimal cut-off value. The cut-off value was found to be 1.72. ConclusionIn our opinion, a high MHR may indicate the presence of immune inflammation and it can be used as a prognostic factor for stricture recurrence after IU. Level of evidence3

Сравнительный анализ результатов лечения пациентов с рецидивной стриктурой уретры с применением плазмы, обогащенной тромбоцитами

Сравнительный анализ результатов лечения пациентов с рецидивной стриктурой уретры с применением плазмы, обогащенной тромбоцитами

Investigation of risk factors in the development of recurrent urethral stricture after internal urethrotomy.

Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen. Although endoscopic methods are mostly used in its treatment, it has high recurrence rates. Therefore, open urethroplasty is recommended after unsuccessful endoscopic treatments. To investigate the risk factors associated with urethral stricture recurrence. The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed. Demographic data, comorbidities, preoperative haemogram, and biochemical values obtained from peripheral blood and operative data were recorded. Patients were divided into two groups in terms of recurrence development; recurrence and non-recurrence. Initially recorded data were compared between the two groups. A total of 303 patients were included in the study. The mean age of the patients was 66.6 ± 13.6 years. The mean duration of recurrence development was 9.63 ± 9.84 (min-max: 1-39) months in the recurrence group. Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15 ± 24.07 (min-max: 12-84) months. In the comparison of both groups, the presence of diabetes mellitus (DM), hypertension (HT), and multiple comorbidities were significantly higher in the recurrence (+) group (P = 0.038, P = 0.012, P = 0.013). Blood group, postoperative use of non-steroidal anti-inflammatory drugs, preoperative cystostomy, cause of stricture, iatrogenic cause of stricture, location and length of stricture, indwelling urinary cathater size and day of catheter removal did not differ between the two groups. No statistically significant difference was observed between the two groups in terms of age, uroflowmetric maximum flow rate value, hemogram parameters, aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting blood sugar, creatinine, glomerular filtration rate, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, monocyte-lymphocyte ratio and AST/ALT ratios. In patients with urethral stricture recurrence, only the frequency of DM and HT was high, while inflammation marker levels and stricture-related parameters were similar between the groups.

Low Serum Testosterone as a Poor Prognostic Marker in Urethral Stricture: A Single-Center Prospective Longitudinal Study.

Introduction Androgens play a key role in modulating periurethral and preputial vascularity, cavernosal smooth muscle integrity, and penile growth. As a result, low testosterone may adversely affect the severity and outcome of urethral stricture patients. So, to find out the hormonal influence on the clinical outcome of urethral stricture we conducted a prospective longitudinal study at our institute. Methods The study was conducted at the Department of Urology, Institute of Post Graduate Medical Education & Research (IPGMER), Kolkata, India, from February 2023 to September 2023. This study was approved by the Institutional Ethics Committee atIPGMER, Kolkata with the approval number IPGMER/IEC/2023/436. Hormonal levels in patients with diagnosed non-traumatic urethral stricture were compared with patients without stricture. Patients with any overt hormonal abnormality or androgen-secreting tumor were excluded. A morning 10 cc blood sample was collected for testosterone, follicle-stimulating hormone, luteinizing hormone, and thyroid-stimulating hormone. The association of hormonal levels was measured in both groups and compared statistically. Any association of hypogonadism (testosterone <300 ng/dL) with respect to length, severity, and recurrence of urethral stricture was also studied. Results Forty patients with urethral stricture and same number of patients without stricture were included in the study. The mean testosterone level was found to be significantly low in patients with stricture (386 ng/dL vs 660 ng/dL). The age-wise distribution also showed low mean testosterone compared to patients without stricture. The incidence of hypogonadism is also found to be higher in stricture patients (47.5% vs 27.5%). It was also observed low testosterone is more prevalent in pan-anterior stricture (10/40) and long-segment stricture(>2 cm). Patients with stricture were also followed up for 6 months for recurrence of symptoms. Thirteen patients had recurrence. Patients with recurrence had significantly low serum testosterone (272 ng/dL vs 440 ng/dL). Conclusion Our study documented stricture patients with low serum testosterone have poor outcomes. Low testosterone level is strongly associated with longer stricture and increased risk of stricture recurrence.

Анализ результатов и осложнений после повторной пластики рецидивных стриктур уретры.

Introduction. Over the past 30 years in reconstructive urology there has been a tendency to reduce the frequency of use of minimally invasive methods of surgical treatment of urethral strictures of various localizations and the predominant use of reconstructive plastic interventions with the expansion of the narrowed area of the urethra using inserts from various tissues. Buccal dilation urethroplasty is currently recognized as the optimal treatment option for urethral strictures of various locations and of varying length. Thus, the issue of choosing the most appropriate method of surgical intervention for recurrent urethral strictures, in the context of a possible increase in the risk of complications, requires additional research. Purpose. To analyze and evaluate the results and complications after plastic surgery of recurrent urethral strictures using a free autograft of the buccal mucosa. Materials and methods. The analysis included data on 51 patients operated on at the Research Institute of Urology and Interventional Radiology named after. N.A. Lopatkina–branch of the Federal State Budgetary Institution National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation for the period from 2014 to 2021 regarding recurrent urethral stricture. The average age of the patients was 36.2±1.6 years (from 18 to 58 years). The diagnosis of recurrent urethral stricture was confirmed by anamnesis, clinical and laboratory examination according to a standard protocol, and special examination methods (uroflowmetry, ultrasound examination of the bladder, retrograde or antegrade cystourethrography, voiding urethrography). According to indications, fibrourethrocystoscopy was performed. According to radiological research methods, the localization and extent of urethral stricture were determined. The functional state of the bladder and the severity of bladder outlet obstruction were determined by the volume of residual urine determined by ultrasound of the bladder, as well as by uroflowmetry data. Results. An analysis of the results and complications after plastic surgery of recurrent urethral strictures using a buccal flap was carried out after repeated operations. As the length of the stricture increases, the risk of its recurrence increases significantly. The most significant factors are the location of the stricture in the penile region and its extent. No other long-term complications (newly developed urinary incontinence/erectile dysfunction) were observed in any case in the analyzed group of patients. Conclusion. Repeated operations for recurrent urethral strictures can eliminate urinary disorders with an effectiveness close to (or equal to) that of primary operations. When choosing a method of surgical treatment of recurrent strictures, both the extent of the stricture and its location should be taken into account. The presence of an extended stricture of the penile urethra may be a risk factor for its recurrence. Complications that develop after repeated operations in the vast majority of cases are not life-threatening. The question of the effectiveness of different types of surgery requires additional research with the accumulation of clinical material.

(205) Functional Outcomes in Non-Transecting Excision-Anastomosis Urethroplasty for Lengthy (≥2cm) Urethral Strictures

Abstract Introduction Spongiosal sparing non-transecting anastomotic bulbar urethroplasty has rapidly become the preferred technique for many reconstructive urologists due to reported improvement in postoperative erectile function outcomes. For strictures &amp;lt;2cm, non-transecting techniques without the use of graft augmentation are typically deployed. However, for lengthy bulbar strictures (≥2cm), many advocate for oral mucosa substitution urethroplasty due to the theoretical concern of penile shortening, tethering, or other erectile function related side effects. Although effective, substitution bulbar urethroplasty is associated with additional graft harvest morbidity and may have lower success rates relative to non-substitution non-transecting techniques. Objective We describe outcomes of an extended non-transecting excision-anastomosis urethroplasty for lengthy urethral strictures without the use of graft augmentation. Methods A tertiary center’s urethroplasty database was queried for patients that underwent non-transecting bulbar urethroplasty from 2017-2023. Patients with penile urethral strictures or concurrent urethroplasty procedures were excluded. Stretch penile length (SPL) was assessed by applying gentle traction on the penis and measuring from the base of the penis to the tip of the glans. SPL was assessed perioperatively and at 3-6 month follow-up. Urethral stricture recurrence was defined as need for repeat urethral intervention. Urethral stricture length was determined by intra-operative measurement. Accordingly, patients were then stratified based on stricture length (&amp;lt;2 cm vs ≥2 cm) and tested for association between categorical outcomes (worsening erectile function and reconstructive success) and continuous outcomes (change in SPL) using Fischer’s exact test and Mann Whitney U test. Results A final cohort of 90 patients were identified, with a median urethral stricture length of 1.5 cm (range 0.5-6cm). In addition to dorsal urethrotomy (median 3cm), ventral mucosectomy was performed in 29 (32%) patients (median 2cm). Early postoperative complications occurred in 13 (15%) including UTI (N=4), contrast extravasation at VCUG (N=3), and epididymo-orchitis (N=3). At a median follow up of 13 months (IQR 4-18), a total of 5.5% (5/90) developed stricture recurrence. The overall median change in SPL was 0% (IQR 0-6.7%). De novo ED occurred in 7% (5/67). When stratified by stricture length ≥2cm (N=41) and &amp;lt;2cm (N=49) median length of urethrotomy was 3 cm (2.6-4.0) vs 2 cm (2.0-3.0; p &amp;lt;0.001), respectively. Those with strictures ≥2 cm had greater decreases in relative SPL (median 3.5% vs. 0%, p = 0.003) and higher absolute PVR (median 71 ml vs. 34 ml, p =0.03) at 3 months after surgery. There were no significant differences in relative improvement of Qmax or PVR, stricture recurrence (8% vs 4%), worsening erectile function (10% vs 6%), or complication rates (15% vs 14%) between groups (p-value&amp;gt; 0.05 for all comparisons). Conclusions Spongiosal sparing non-transecting urethroplasty is an effective surgical option for patients with lengthy urethral strictures. It offers comparable relative improvement in functional (Qmax, PVR) and erectile function outcomes, while having a modest impact on SPL all while avoiding the morbidity of graft harvesting. Disclosure No.

The Effect of Botulinum Toxin (Masport) Injection Following Internal Urethrotomy of Bulbar Urethral Stricture: A Pilot Study.

The application of Botulinum toxin (Masport) in urology has a long history. We aimed to assess the effect of local Masport on improvement in patients with urethral stricture by reducing the recurrence of urethral stricture. This pilot study conducted was a double-blind randomized clinical trial with code IRCT20191222045852N1 on patients suffering from urethral stricture. Finally, 28 patients were allocated to intervention and control groups. Twelve patients received intralesional injection with Masport in addition to internal urethrotomy, while 16 patients underwent internal urethrotomy with normal saline. The Cox regression hazard model was used to evaluate the effect of treatment status on recurrence time adjusted for the age, length, and location of the stenosis, cause of the stenosis, and history of previous operations. The effect of treatment type was significant at the .05 level. The past medical history and cause of urethral stricture had a significant impact on relapse-free survival. Also, the improvement in the mean score of the EuroQol Visual Analogue Scale (EQ-VAS), International Prostate Symptom Score (IPSS), and Q-max in the group with Masport was significantly different from the group with normal saline. The internal urethrotomy with intralesional injection of Masport has a better survival prognosis than internal urethrotomy with normal saline group. Therefore, the authors suggest that, given this successful initial clinical trial, consideration be given to future studies involving the use of botox in the management of urethral strictures in conjunction with internal urethrotomy.

Thermoexpandable Memokath stent: Usage and efficacy in ureteral and urethral strictures in Saudi Arabia.

Double J (DJ) stent is widely used in cases of ureteric strictures as a temporary solution; however, it has certain limitations, such as the need for frequent exchange. Alternatively, a long-lasting thermoexpandable stent (Memokath™ 051) has been used to relieve ureteral obstructions in comorbid patients with multiple reported advantages, such as longer durability which avoids the need of frequent exchanges. In addition, it can be used in certain cases of urethral strictures. Our study is the first in the region to report the experience and outcome of Memokath stent with ureteral and urethral strictures. After local IRB approval, we retrospectively reviewed records of 21 patients who underwent insertion of Memokath 051 stent in the ureter and Memokath 045 in the urethra between 2013 and 2021. Indications of insertion, indwelling duration, and causes of removal were collected and analyzed by SPSS. Twenty-one patients received 21 Memokath stents for 11 ureteral strictures and 10 urethral strictures. Fifty-five percent of ureteral strictures were malignant, and 27.3% of the benign ureteric strictures were transplant ureters. Ureteric memokath stents remained functioning for a mean of 16.1 months. Mean indwelling time for transplant ureteric memokath stents was 24.3 months. Total 4 ureteric stents had migrated, 4 stents blocked, and 2 stents were removed as planned and 1 stent removed due to febrile urinary tract infection (UTI). Ten urethral stents remained in place for mean of 14 months. Three stents were removed as planned with resolution of stricture, two were removed due to blockage, three stents had UTI, one was removed due to pain, and one stent remained functioning until the patient expired. Our outcome is comparable to other published studies, suggesting that ureteric Memokath stent is a better option with adequate indwelling time, especially in transplant ureters, in comparison with DJ stents. In addition, Memokath stents can be used in selected recurrent urethral strictures where surgical reconstruction is not feasible.

Inflammation indexes and machine-learning algorithm in predicting urethroplasty success.

To assess the predictive capability of hematological inflammatory markers for urethral stricture recurrence after primary urethroplasty and to compare traditional statistical methods with a machine-learning-based artificial intelligence algorithm. Two hundred eighty-seven patients who underwent primary urethroplasty were scanned. Ages, smoking status, comorbidities, hematological inflammatory parameters (neutrophil-lymphocyte ratios, platelet-lymphocyte ratios [PLR], systemic immune-inflammation indexes [SII], and pan-immune-inflammation values [PIV]), stricture characteristics, history of previous direct-visual internal urethrotomy, urethroplasty techniques, and grafts/flaps placements were collected. Patients were followed up for one year for recurrence and grouped accordingly. Univariate and multivariate logistic regression analyses were conducted to create a predictive model. Additionally, a machine-learning-based logistic regression analysis was implemented to compare predictive performances. p<0.05 was considered statistically significant. Comparative analysis between the groups revealed statistically significant differences in stricture length (p=0.003), localization (p=0.027), lymphocyte counts (p=0.008), PLR (p=0.003), SII (p=0.003), and PIV (p=0.001). In multivariate analysis, stricture length (odds ratio [OR] 1.230, 95% confidence interval [CI] 1.142-1.539, p<0.0001) and PIV (OR 1.002, 95% CI 1.000-1.003, p=0.039) were identified as significant predictors of recurrence. Classical logistic regression model exhibited a sensitivity of 0.76, specificity of 0.43 with an area under curve (AUC) of 0.65. However, the machine-learning algorithm outperformed traditional methods achieving a sensitivity of 0.80, specificity of 0.76 with a higher AUC of 0.82. PIV and machine-learning algorithms shows promise on predicting urethroplasty outcomes, potentially leading to develop possible nomograms. Evolving machine-learning algorithms will contribute to more personalized and accurate approaches in managing urethral stricture.

RISK FACTORS OF URETHRAL STRICTURE: A SYSTEMATIC REVIEW

Background: Urethral stricture in males is a narrowing of the anterior urethra caused by fibrosis and cicatrisation of the urethral mucosa and adjacent spongiosus tissue ("spongiofibrosis"). In the male posterior urethra, there is no spongiosus tissue; therefore, stenosis is the preferred term. Understanding the risk factors of urethral strictures may be amenable to preventive measures resulting in a decrease in disease severity and health care expenditure. Aim: This study aims to summarize and assess the risk factors of urethral stricture through a comprehensive systematic review. Methods: A systematic search strategy was conducted across several electronic reference databases (PubMed, Cochrane Library, Google Scholar) and included articles published between 2013–2023. Duplicate publications, review articles, and incomplete articles were excluded. Results: The databases search identified a total of 16.645 articles (Table 1) and resulted in 16.155 articles after duplicates removed. Of these, 15.955 articles were excluded due to non-original study and titles and abstract not represented the focus of interest; and resulting in 200 articles for screening process. Articles not evaluating the focus of interest and articles in which full-text are not available are excluded, resulting in 15 articles for eligibility criteria. Among them, 10 articles did not give sufficient details about the risk factors of urethral stricture and some did nit differenriate clearly between the risk factors of urethral stricture and recurrence of urethral stricture. Hence, we found 5 appropriate studies included. Conclusion: The risk factors of urethral stricture in this study includes the dose of brachyterapy for prostate cancer patients, lower resection speed of BPH, prolonged operative time, intraoperative urethral mucosa rupture, post-operative continuous infection, the diameter of the instrument, presence of chronic prostatitis in anamnesis, increased volume of the prostate, repeated drainage of the bladder using the urethral catheter, high comorbidity burden, second TURP surgery, history of preoperative catheter insertion, high postoperative WBC, and long postoperative catheterization time.