Recurrent Urethral Stricture Research Articles

ONE-YEAR EVALUATION OF OVERALL URETHRAL STRICTURE MANAGEMENT USING QUESTIONNAIRES AND UROFLOWMETRY

Objective: To evaluate the overall outcomes of patients who get definitive treatment of urethral stricture. Material & Method: All patients who underwent various urethral stricture management in Cipto Mangunkusumo Hospital were evaluated over 1 year period. Patient demographics, type of surgery, International Prostate Symptoms Score (IPSS), quality of life (QoL) score, flow rate (FR) and post void residual urine (PVR) of all patients were evaluated at 3 months, 6 months and 1 year after surgery. Results: Out of 230 urethral stricture patients, 65 patients were eligible this study. Mean patient age was 41.19 ± 20.44 years. 37Direct Vision Internal Urethrotomy (DVIU), 20 end-to-end anastomosis, and 8 graft urethroplasties were performed. All patients underwent urethral stricture management showed improvement of IPSS (-22.64, p < 0.001), QoL (-3.36, p < 0.001), FR (16.72 ml/s, p < 0.001) and PVR (-126.23 ml, p < 0.001). Compliant patients showed better improvement of IPSS and FR than non compliant patient after DVIU procedure. Overall, open surgery give better improvement of IPSS and FR than DVIU procedure. These differences were more pronounced in recurrent and long (≥ 2 cm) urethral stricture disease. In open surgery group, end-to-end anastomosis give better improvement in FR compared to graft urethroplasty. Conclusion: Patients undergoing urethral stricture management experienced a significant improvement in self-reported outcomes and functional uroflow studies. Overall, open surgery gives better improvement in FR and IPSS than DVIU procedure. In open surgery group, end-to-end anastomosis give better improvement compares to graft urethroplasty.Keywords: International Prostate Symptoms Score, quality of life, flow rate, post void residual urine, urethral stricture.

V7-14 OPTIMIZING PORT PLACEMENT AND DOCKING FOR ROBOTIC KIDNEY SURGERY

INTRODUCTION AND OBJECTIVES: Intraurethral fibrotic scar formation accompanied by spongiofibrosis is a main cause recurrent urethral stricture after initial management with direct vision internal urethrotomy (DVIU) or dilatation. Here, we report on technical feasibility and short-term outcome of a new technique: Transurethral resection of pre-formed fibrotic tissue before the placement of a thermo-expandable urethral stent for distal urethral stricture. METHODS: The clinical records of 11 consecutive patients with distal urethra stricture (9 bulbous, 3 penile) were retrospectively reviewed (April 2011e February 2013). As a first step, all patients were treated with transurethral resectionoffibrotic tissueusing13Frpediatric resectoscope to the level of normal looking corpus spongiosum and, then thermo-expandable urethral stents (MemokathTM044TW)were deployedaccording to the conventional protocol. Stents were removed in 6-12 months of initial placement and urethral patency was determined in terms of the ability of pass 17Fr cystoscopy and the normal range of uroflowmetry (maximum flow rate (Qmax) i~ A15ml/sec). Alsooperational feasibility of new technique with focus on periand post-operative complication was accessed. RESULTS: Mean age of patients and operation time were 58.9 (32-83) years and 84.5 (30-110) minutes respectively. Mean follow-up duration was 14.9 (7-30) months and during this period in 9 from 11 patients, urethral stents were removed. Mean post-op Qmax (18.7i/45.7ml/sec) was significantly higher than that of pre-op (10.5i/42.6ml/sec, p < 0.05). Post-op urethral dilatation was performed mean 1.2 times (1-5) in 5 patients but no patients needed open urethroplasty during follow-up period. There were no significant complications including severe urethral bleeding, incontinence, erectile dysfunction, and intractable pain. CONCLUSIONS: Combined transurethral resection of fibrotic scar tissue and temporary urethral stenting is feasible, safe, and efficient technique for distal urethral stricture.

MP13-12 MIDTERM FOLLOW UP OF INTERNAL URETHROTOMY IN PATIENTS WITH RECURRENT URETHRAL STRICTURE AFTER BUCCAL MUCOSA GRAFT URETHROPLASTY

INTRODUCTION AND OBJECTIVES: To determine the success rate of internal urethrotomy (IU) in the treatment of short stricture recurrences after buccal mucosa urethroplasty (BMGU). METHODS: All patients who underwent IU for the treatment of short urethral stricture recurrence (< 1cm) after BMGU were identified from our prospective urethroplasty data base.These patients were evaluated by maximum flow rate (Qmax) and residual urine (RU) measurements. Stricture recurrence was determined when maximum flow rate (Qmax) was < 10 ml/s and a stricture verified in a combined retroand antegrade voiding cystography (VC) or cystoscopy. Endpoints of our retrospective study was to determine the success rate of IU and possible risk factors of stricture recurrence after IU. RESULTS: A total of 27 IU patients after failed BMGU were identified. Mean FU of this study cohort was 12.4 months (range 1-32). At baseline mean age was 60 years (range 19-79). A bulbar BMGU was performed in 89% and a penile urethroplasty in 11% respectively. Mean length of the graft used was 6 cm. Relapse occurred proximal to the graft in 71%, distal to the graft in 29% After IU stricture recurrence was observed in 44.4% of our study patients. Mean Qmax in FU was 16.59 ml/s, mean RU was 91 ml. According to Kaplan Meyer Analysis at 30 months the success rate of IU was about 50% (see figure 1). Neither age nor a history of radiotherapy nor number of previous urethral surgeries were statistically significantly associated with stricture recurrence after IU. In linear regression length of the graft showed borderline statistical significance (p1⁄40.078). CONCLUSIONS: At midterm FU IU after BMGU showed a fair success rate and might be a viable option in paients with very short strictures after BMGU. Longer FU is warranted. Source of Funding: none

MP13-13 PROPENSITY MATCHED COMPARISON OF MORBIDITY AND COSTS OF OPEN VS. MINIMALLY INVASIVE RADICAL NEPHROURETERECTOMY: A CONTEMPORARY POPULATION-BASED ANALYSIS IN THE UNITED STATES

INTRODUCTION AND OBJECTIVES: To determine the success rate of internal urethrotomy (IU) in the treatment of short stricture recurrences after buccal mucosa urethroplasty (BMGU). METHODS: All patients who underwent IU for the treatment of short urethral stricture recurrence (< 1cm) after BMGU were identified from our prospective urethroplasty data base.These patients were evaluated by maximum flow rate (Qmax) and residual urine (RU) measurements. Stricture recurrence was determined when maximum flow rate (Qmax) was < 10 ml/s and a stricture verified in a combined retroand antegrade voiding cystography (VC) or cystoscopy. Endpoints of our retrospective study was to determine the success rate of IU and possible risk factors of stricture recurrence after IU. RESULTS: A total of 27 IU patients after failed BMGU were identified. Mean FU of this study cohort was 12.4 months (range 1-32). At baseline mean age was 60 years (range 19-79). A bulbar BMGU was performed in 89% and a penile urethroplasty in 11% respectively. Mean length of the graft used was 6 cm. Relapse occurred proximal to the graft in 71%, distal to the graft in 29% After IU stricture recurrence was observed in 44.4% of our study patients. Mean Qmax in FU was 16.59 ml/s, mean RU was 91 ml. According to Kaplan Meyer Analysis at 30 months the success rate of IU was about 50% (see figure 1). Neither age nor a history of radiotherapy nor number of previous urethral surgeries were statistically significantly associated with stricture recurrence after IU. In linear regression length of the graft showed borderline statistical significance (p1⁄40.078). CONCLUSIONS: At midterm FU IU after BMGU showed a fair success rate and might be a viable option in paients with very short strictures after BMGU. Longer FU is warranted. Source of Funding: none

The stone formation in the Memotherm urethral stent implantation area: Is it a rare complication?

Recurrent urethral stricture is one of the biggest problems in urology. Urethral stents as an alternative treatment has been used since 1985. The stone formation in the Memotherm (Angiomed) urethral stent implantation area is a rare complication. We report the case of a 67-year-old man who had a stone in the Memotherm urethral stent implantation area 6 years after his urethral stent surgery.

Oral Mucosa Harvest for Urologic Reconstruction

The aim of this study was to present retrospective analysis of our experience regarding complications associated with the donor site after oral mucosa harvest for urethral reconstruction. Between May 2010 and January 2013, a total of 18 patients with recurrent urethral strictures received a buccal mucosal graft for urethral reconstruction at the San Giovanni Battista Hospital, University of Turin, Turin. All operations were performed in a 2-team approach. All patients were retrospectively evaluated by clinical examination and using a questionnaire. Urethroplasty with oral mucosa graft was performed successfully in a 1-step procedure in 17 of 18 patients. No intraoperative complications were observed.The most common complication occurring at the buccal donor site was scarring and contracture (n = 3). Oral mucosa graft for urethroplasty is a simple and safe method in the interdisciplinary treatment of urethral strictures. Donor-site morbidity measured by clinical assessment and questionnaire is tolerable.

Long-term results of permanent memotherm urethral stent in the treatment of recurrent bulbar urethral strictures

To evaluate the long term outcomes of permanent Memotherm urethral stent in the treatment of recurrent bulbar urethral stricture. Twenty patients who underwent permanent Memotherm urethral stent implantation due to recurrent bulbar urethral stricture following previous unsuccessful surgical procedure from 1996 to 2002 were included in the study. Long-term outcomes of the patients were evaluated. The overall success rate was 87.5% at the end of the tenth year. There was discomfort in implantation area in eight patients about 1 month following the procedure. These patients were treated with alpha-blocker and anti-inflammatory drugs. Stone formation was observed at the urethral stent implantation area in two patients. Post-void dripping has been observed in 15 patients up to the postoperative 3rd month. Stress urinary incontinence was observed in a patient with a 1-year follow-up. Partial stent migration was observed in two patients. None of the patients experienced pain during erection. Memotherm urethral stent is a minimal invasive surgical procedure which can be safely and effectively used in patients with recurrent urethral stricture.

Re: The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study

Journal of EndourologyVol. 28, No. 5 Letters to the EditorDean G. Assimos, MD, Section EditorRe: The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study(From: Chung JH, Kang DH, Choi HY, et al. J Endourol 2013;27:756–762)Ye Tian, Romel Wazir, and Kunjie WangYe TianSearch for more papers by this author, Romel WazirSearch for more papers by this author, and Kunjie WangSearch for more papers by this authorPublished Online:18 Apr 2014https://doi.org/10.1089/end.2013.0553AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Re: The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study." Journal of Endourology, 28(5), p. 612FiguresReferencesRelatedDetails Volume 28Issue 5May 2014 InformationCopyright 2014, Mary Ann Liebert, Inc.To cite this article:Ye Tian, Romel Wazir, and Kunjie Wang.Re: The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study.Journal of Endourology.May 2014.612-612.http://doi.org/10.1089/end.2013.0553Published in Volume: 28 Issue 5: April 18, 2014Online Ahead of Print:December 28, 2013Online Ahead of Editing: October 30, 2013PDF download

Predictors for recurrence after urethroplasty in pediatric and adolescent stricture urethra

ObjectiveThis study aims at evaluating factors predicting recurrence of urethral stricture following urethroplasty in pediatric patients at a tertiary care center. Patients and methodsFifty-two patients of up to 18 years of age, who underwent urethroplasty, were reviewed. Duration of symptoms, etiology, previous intervention, and site of stricture, surgical modality, stricture length, and spongiofibrosis at stricture site, recurrence, and ancillary procedures required were recorded. ResultsForty-two (82.76%) patients (Group I) had recurrence-free course on follow-up. Of the 10 patients with recurrence (Group II), 9 had PTS and 1 had IS (p = 0.04). Most of the factors evaluated did not differ statistically between the groups; however, length of stricture (1.8 vs. 4.3 cm, p < 0.001) and degree of spongiofibrosis (61% vs. 90%, p = 0.003) were significantly different. Seven patients with recurrence were managed with single procedures, but three required multiple procedures because of multiple recurrences. History of incision and drainage for paraurethral abscess was significantly higher (28.6% vs. 100%, p = 0.002) in patients who had multiple recurrences. ConclusionsEtiology, fibrosis at local site, and stricture length have significant impact on recurrence of pediatric urethral stricture disease. Associated paraurethral abscess may further compromise the outcome of urethroplasty.

Recurrence and complications after transperineal bulboprostatic anastomosis for posterior urethral strictures resulting from pelvic fracture: a retrospective study from a urethral referral centre

To describe the complications of transperineal end-to-end anastomotic urethroplasty in patients with posterior urethral strictures resulting from pelvic fracture. A total of 573 patients, who underwent bulboprostatic anastomosis for posterior urethral strictures, were enrolled in this study. Distraction defects were measured using retrograde urethrography combined with voiding cysto-urethrography. All patients underwent perineal excision and primary anastomotic urethroplasty. The urethroplasty was considered successful if the patient was free of stricture-related obstruction and did not require any further intervention. The degree of stress incontinence was assessed daily by pad testing. The prevalence of pre- and postoperative sexual disorders was investigated using the International Index of Erectile Function-5 questionnaire. Of 573 bulboprostatic anastomosis procedures performed, 504 (88%) were successful and 69 (12%) were not successful. The mean (sd) maximum urinary flow rate, assessed by uroflowmetry 4 weeks after surgery, was 20.52 (5.1) mL/s. Intraoperative rectal injury was repaired primarily in 28 cases. Recurrence of urethral strictures was observed in 10 (1.7%) patients during the first 6 months after surgery, and in 45 patients from 6 months to 1 year. All of these patients underwent re-operation. Twenty-four (4.2%) patients had mild urge incontinence and 28 (4.9%) had mild stress incontinence. Erectile dysfunction (ED) was present in two (<0.1%) patients before trauma and in 487 (85%) patients after trauma. There was no statistical difference between the incidences of preoperative and postoperative ED (85 vs 86%, P > 0.05). Nine (1%) patients were found to have false passage between the posterior urethra and bladder neck. The majority of complications associated with transperineal bulboprostatic anastomosis can be avoided as long as meticulous preoperative evaluation to define the anatomy and careful intra-operative manipulation are ensured.

Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer

To compare the safety and efficacy of conventional monopolar transurethral resection of bladder tumour (TURBT) and 2-micron continuous-wave laser resection (2-µm laser) techniques in the management of multiple nonmuscle-invasive bladder cancer (NMIBC), and to investigate long-term effects on tumour recurrence. Patients with multiple NMIBC were randomized to receive TURBT or 2-µm laser in a nonblinded manner. All patients received intravesical chemotherapy with epirubicin (40 mg/40 ml) for 8 weeks, beginning 1 week after surgery, followed with monthly maintenance therapy for 12 months. Three-year follow-up data of preoperative, operative and postoperative management were recorded. In total, 120 patients were included: 56 in the TURBT group and 64 in the 2-µm laser group. Intra- and postoperative complications (including bladder perforation, bleeding and irritation) were less frequently observed in the 2-µm laser group compared with the TURBT group. There were no significant differences in first time to recurrence, overall recurrence or occurrence of urethral strictures. The 2-µm laser resection method was more effective than TURBT in reducing rates of intra- and postoperative complications, but offered no additional benefit regarding tumour recurrence.

The Effects of Hyaluronic Acid and Carboxymethylcellulose in Preventing Recurrence of Urethral Stricture After Endoscopic Internal Urethrotomy: A Multicenter, Randomized Controlled, Single-Blinded Study

To evaluate the effects of hyaluronic acid (HA) and carboxymethylcellulose (CMC) on the recurrence of urethral stricture after treatment with endoscopic internal urethrotomy (EIU). A total of 120 patients underwent EIU for urethral stricture. Recruited patients were randomly divided into two groups: group A and B. Patients in group A (60 patients, experimental group) received HA/CMC instillation and patients in group B (60 patients, control group) received lubricant instillation after internal urethrotomy. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), and 24 weeks (V3) after the surgery. The effectiveness of HA/CMC instillation was evaluated based on the International Prostate Symptom Score/Quality of Life, peak urine flow rate, voided volume and postvoiding residual urine volume. The visual analogue scale (VAS) pain score and degree of satisfaction were also determined for each participant. Among 120 initial participants, 53 patients in group A and 48 patients in group B had completed the experiment. VAS pain scores were 0.67±0.76 and 3.60±1.52 (p<0.001), and degrees of satisfaction were 0.28±0.50 and 0.80±0.81 in group A and group B at 1 month after surgery (p=0.001). The recurrence of urethral stricture was observed in five cases (9.4%) in group A and 11 (22.9%) in group B (p=0.029). HA/CMC instillation during EIU may decrease the incidence of urethral stricture recurrence. In addition, the use of HA/CMC was effective in reducing pain during the early postoperative period without an adverse effect.

Short-Term Outcome and Morbidity of Different Contemporary Urethroplasty Techniques—A Preliminary Comparison

Only few comparative reports about different urethroplasties have been published, addressing success rate (SR), adverse events (AE), and quality of life (QoL). Our purpose was to evaluate SR, AE, and QoL in a contemporary cohort of patients undergoing urethroplasty in the short-term follow-up (FU). Between December 2008 and June 2010, 205 patients underwent urethroplasty for anterior urethral strictures at our institution. A standardized questionnaire was sent to all patients. The primary end point was SR. Secondary end points were AE and QoL. To assess the risk of SR, the Kaplan-Meier method and log-rank test were used. To assess risk factors for urethral stricture recurrence (SRec), univariable Cox regression analysis was used. Overall, 140 (68%) patients responded to our questionnaire and were used for analysis. Of these 9%, 85%, and 6% were treated by excision and primary anastomosis (EPA), buccal mucosa graft urethroplasty (BMGU), and mesh graft urethroplasty (MGU), respectively. At 10 months of FU, SR was 87.5%. SRs of EPA, BMGU, and MGU were 100% (n=13/13), 85.7% (n=102/119), and 87.5% (n=7/8), with no significant differences between the groups. In univariable analysis, ≥ 2 vs 1 previous urethroplasties showed a trend toward a reduced SR (hazard risk 2.95; P=0.057). Streaking the urethra (P=0.024) and penile curvature (P=0.026) were significantly more often associated with MGU compared with EPA and BMGU. Postoperative total median (mean) scores were 3.5 (4.8) for the International Consultation on Incontinence Questionnaire Male lower urinary tract symptoms, 15 (15.2) for the International Index of Erectile Function, and 80 (73) for EuroQol visual analogue score; there was no difference between urethroplasty types. In the short-term FU, urethroplasty demonstrates an excellent SR. Specific SRs of EPA, BMGU, and MGU seem comparable. Despite significant differences in AE, patient reported QoL is high with no difference between the applied techniques.

762 ENDOSCOPIC MANAGEMENT OF RECURRENT POSTERIOR URETHRAL STRICTURES (PUS) WITH VISUAL INTERNAL URETHROTOMY (VIU) AND INJECTION OF MITOMYCIN C (MMC)

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (II)1 Apr 2013762 ENDOSCOPIC MANAGEMENT OF RECURRENT POSTERIOR URETHRAL STRICTURES (PUS) WITH VISUAL INTERNAL URETHROTOMY (VIU) AND INJECTION OF MITOMYCIN C (MMC) James Rybak and Laurence Levine James RybakJames Rybak Chicago, IL More articles by this author and Laurence LevineLaurence Levine Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recurrent posterior urethral strictures pose a challenging therapeutic dilemma. Surgery is complex and difficult. MMC has been shown to reduce fibroblast and scar proliferation. It has been previously studied to be a safe minimally invasive approach for recurrent bladder neck contractures (BNC) following radical prostatectomy. This study assessed patient outcomes following VIU and injection with MMC in a patient population with a variety of complex and radiation induced PUS. METHODS Retrospective chart review from our database of reconstructive surgery with PUS between 2010 and 2012 that had failed previous intervention with at least 1 prior VIU. Quadrant cold knife incisions of the scar were performed followed by 0.3-0.5mg/ml injections of MMC at each incision site; a total of 10 mL was used in each scar. Postoperative flexible cystoscopy and post void residual (PVR) assessed urethral patency postoperatively at 1,3,6,12 months. RESULTS 14 patients were treated with VIU and injection of MMC. All pt's had failed a mean of 2.5 prior procedures (1-4) Mean follow-up was at 8 months (1-14). Average scar length was 1.5cm (1-2.5cm). 42% (6/14) had post brachytherapy induced strictures. 2 patients had strictures from previous RALP, 1 had postoperative external beam radiation s/p RRP. 2 patients had a BNC after holmium laser ablation of the prostate, 1 after TUNA, 2 had strictures from prior failed urethroplasties. Complications were seen in 2/14 patients, 1 needed surgical intervention for a urethral false passage after self catheterization, 1 experienced gross hematuria necessitating clot evacuation. 11/14 patients were continent at baseline and 11/14 remained continent post procedure. 14/14 pt's had patent posterior urethral stricture confirmed by flexible cystoscopy at follow up. Average PVR improved from mean 148ml to 31.25ml post procedure. 3/14 (21%) needed repeat procedure for stricture recurrence. 2/14 patients had successful placement of artificial urinary sphincter with a patent urethra seen intraoperatively. CONCLUSIONS Management of recurrent proximal urethral strictures is one of the most challenging reconstructive problems. In our series it appears that VIU or resection of PUS with injection of MMC can provide a minimally invasive tool to manage these strictures without significant morbidity, even in patients with radiation-induced disease. In those men who have urinary incontinence, successful sphincter placement is offered when there is no stricture recurrence or > 6 months. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e313 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Rybak Chicago, IL More articles by this author Laurence Levine Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

377 MANAGEMENT OF HYPOSPADIAS CRIPPLES WITH TWO-STAGED BRACKA TECHNIQUE: FUNCTIONAL RESULTS IN THE LONG-TERM FOLLOW-UP

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery (III)1 Apr 2013377 MANAGEMENT OF HYPOSPADIAS CRIPPLES WITH TWO-STAGED BRACKA TECHNIQUE: FUNCTIONAL RESULTS IN THE LONG-TERM FOLLOW-UP Silke Riechardt, Roland Dahlem, and Margit Fisch Silke RiechardtSilke Riechardt Hamburg, Germany More articles by this author , Roland DahlemRoland Dahlem Hamburg, Germany More articles by this author , and Margit FischMargit Fisch Hamburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1765AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In patients called ‘hypospadias cripples' because of recurrent urethral strictures, deviation or fistulas after several interventions the functional outcome of reconstructions is seldom reported. The two-staged buccal mucosa urethroplasty remains an option for these patients. We present a large series with long-term functional follow-up. METHODS Between 2002 and 2011 a two-staged buccal mucosa urethroplasty was performd in 49 patients (age 5-69 years, mean 36, median 27). Most of the patients had initially penile (47%) or penoscrotal (26.5%) hypospadias, two had perineal hypospadias and 6 had additional BXO. They had 1 to 30 previous surgeries (mean 4.6). Most of the patients came for reconstruction because of strictures (89.8%). Additionally we found serious deviation (46.9%), fistulas (14.3%), recurrent urinary tract infections (26%), hair in the urethra (16%) and one urethral stone. For long-term follow-up patients were contacted by questionnaire. 38 (77.5%) answered, mean follow-up is 36 months (4-100 months), median is 46 months. RESULTS After the first 6 months postoperatively recurrent stenosis was observed in 5 patients (10 %), from whom 3 were treated conservatively, 2 patients got a meatotomy. In the long term follow-up no further complications occurred. According to the questionnaire 63% of the patients void with a good or excellent urinary stream, 95% without any residual urine. 18 (47%) patients suffer of postvoiding dribbling. 11 patients (28.9%) reported problems with the donor side, mainly numbness, only 3 (8%) patients needed reconstruction because of scars. 33 (87%) patients reported no or only slight change of the erectile function. Slight or no deviation postoperatively is seen in 36 (95%) patients, slight or no shortening of the penis in 35 (92%) patients. 26 (68%) patients had no change of ejaculation, the changes which are reported had been mainly less volume or less pressure. Only two patients (5%) had a serious change of their erectile function. 30 (79%) patients were satisfied or very satisfied with the outcome. CONCLUSIONS The two-staged buccal mucosa urethroplasty is a good option in hypospadias cripples. A good functional outcome can be achieved with no further complications in the long-term follow-up and satisfaction rates of nearly 80%. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e153 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Silke Riechardt Hamburg, Germany More articles by this author Roland Dahlem Hamburg, Germany More articles by this author Margit Fisch Hamburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

378 RELIABILITY OF A NEW STAGING SYSTEM FOR ANTERIOR URETHRAL STRICTURES

INTRODUCTION AND OBJECTIVES: In patients called ‘hypospadias cripples’ because of recurrent urethral strictures, deviation or fistulas after several interventions the functional outcome of reconstructions is seldom reported. The two-staged buccal mucosa urethroplasty remains an option for these patients. We present a large series with long-term functional follow-up. METHODS: Between 2002 and 2011 a two-staged buccal mucosa urethroplasty was performd in 49 patients (age 5-69 years, mean 36, median 27). Most of the patients had initially penile (47%) or penoscrotal (26.5%) hypospadias, two had perineal hypospadias and 6 had additional BXO. They had 1 to 30 previous surgeries (mean 4.6). Most of the patients came for reconstruction because of strictures (89.8%). Additionally we found serious deviation (46.9%), fistulas (14.3%), recurrent urinary tract infections (26%), hair in the urethra (16%) and one urethral stone. For long-term follow-up patients were contacted by questionnaire. 38 (77.5%) answered, mean follow-up is 36 months (4-100 months), median is 46 months. RESULTS: After the first 6 months postoperatively recurrent stenosis was observed in 5 patients (10 %), from whom 3 were treated conservatively, 2 patients got a meatotomy. In the long term follow-up no further complications occurred. According to the questionnaire 63% of the patients void with a good or excellent urinary stream, 95% without any residual urine. 18 (47%) patients suffer of postvoiding dribbling. 11 patients (28.9%) reported problems with the donor side, mainly numbness, only 3 (8%) patients needed reconstruction because of scars. 33 (87%) patients reported no or only slight change of the erectile function. Slight or no deviation postoperatively is seen in 36 (95%) patients, slight or no shortening of the penis in 35 (92%) patients. 26 (68%) patients had no change of ejaculation, the changes which are reported had been mainly less volume or less pressure. Only two patients (5%) had a serious change of their erectile function. 30 (79%) patients were satisfied or very satisfied with the outcome. CONCLUSIONS: The two-staged buccal mucosa urethroplasty is a good option in hypospadias cripples. A good functional outcome can be achieved with no further complications in the long-term follow-up and satisfaction rates of nearly 80%.

1 IDENTIFYING PATIENTS AT RISK FOR COMPLICATIONS OF URETHRAL STRICTURE: THE EFFECT OF PATIENT AGE AND STRICTURE LENGTH

You have accessJournal of UrologyTrauma/Reconstruction: Traum & Reconstructive Surgery (1)1 Apr 20131 IDENTIFYING PATIENTS AT RISK FOR COMPLICATIONS OF URETHRAL STRICTURE: THE EFFECT OF PATIENT AGE AND STRICTURE LENGTH Keith Rourke and Lucas Dean Keith RourkeKeith Rourke Edmonton, Canada More articles by this author and Lucas DeanLucas Dean Edmonton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1375AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although urethral stricture can certainly diminish patient-reported quality of life, a substantial proportion of patients will experience significant complications including renal failure, urethral abscess, acute urinary retention and difficult catheterization. The objective of this study is to determine which clinical factors are associated with complications of urethral stricture specifically at the time of presentation. METHODS A retrospective analysis of presenting symptoms was performed on a cohort of 611 patients presenting with anterior urethral stricture from July 2004 to June 2010. Complications of stricture were recorded and compared to patient age, stricture length, stricture etiology and other patient demographics. Renal failure related to the stricture, urethral abscess, acute urinary retention requiring emergent urologic intervention and difficult catheterization requiring emergent urology intervention were considered significant complications. RESULTS Of the 611 patients, 240 patients (39%) had a complication directly related to urethral stricture including acute urinary retention (30%), difficult catheterization (14%), urethral abscess (7%), and renal failure (4%). Stricture length was predictive of complications, with 50% of those ≥6cm having a complication compared to 36% of those <6cm (p=0.001). Age over the mean age of 50 was also associated with a greater likelihood of complication (44% vs. 35%, p=0.025). Men with stricture secondary to hypospadias had the highest complication rate of 49%, followed by iatrogenic stricture (48%), lichen sclerosis (37%), and idiopathic and trauma (36%) (p=0.163). Penile strictures were associated with the highest rate of complications (48%), when compared to panurethral (41%) and bulbar strictures (36%) but did not achieve statistical significance (p=0.075). CONCLUSIONS For many patients urethral stricture is a morbid condition. While all patients with recurrent urethral stricture potentially benefit from urethroplasty, older patients and patients with long strictures are at highest risk of associated complications. Despite potentially lower success rates with urethroplasty these patients should be strongly encouraged to pursue definitive treatment with urethroplasty. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e1 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keith Rourke Edmonton, Canada More articles by this author Lucas Dean Edmonton, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of a Temporary Thermo-Expandable Stent on Urethral Patency After Dilation or Internal Urethrotomy for Recurrent Bulbar Urethral Stricture: Results from a 1-Year Randomized Trial

The long-term success rate of dilation and/or internal urethrotomy is low in cases of recurrent urethral stricture. We investigated the ability of the Memokath™ 044TW stent to maintain urethral patency after dilation or internal urethrotomy for recurrent urethral stricture. A total of 92 patients with recurrent bulbar urethral strictures (mean length 2.7 cm) were treated with dilation or internal urethrotomy and randomized to short-term urethral catheter diversion (29) or insertion of a Memokath 044TW stent (63). The primary end point was urethral patency, as assessed by passage of a calibrated endoscope. Secondary end points included urinary symptoms and uroflowmetry parameters. Stents were scheduled to remain in situ for 12 months. The rate of successful stent insertion was 93.6% (59 of 63 patients). In stented patients patency was maintained significantly longer than controls (median 292 vs 84 days, p <0.001). Patency was reflected in significantly improved uroflowmetry and symptom scores. The stent was removed in 100% of patients. The most frequently noted side effects in stented patients were bacteriuria, hematuria and penile pain, which were usually mild and transient. There was no difference in sexual function between stented and control patients. Stent dislocation and occlusion were observed in 8 and 3 patients, respectively. Patients with recurrent bulbar urethral strictures treated with dilation or urethrotomy and a Memokath 044TW stent maintained urethral patency significantly longer than those treated with dilation or urethrotomy alone. The stent side effect profile was favorable. The stent was straightforward to insert and it was removed without difficulty even after long-term placement.

Early Experience With a Thermo-Expandable Stent (Memokath) for the Management of Recurrent Urethral Stricture

PurposeTo report our early experience with thermo-expandable urethral stents (Memokath) for the management of recurrent urethral stricture and to assess the efficacy of urethral stents.Materials and MethodsBetween March 2012 and February 2013, 13 patients with recurrent urethral stricture after several attempts with direct visual internal urethrotomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation included uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis.ResultsThe mean patient age was 47.7 years (range, 18 to 74 years). The mean urethral stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile urethral strictures, respectively. The overall success rate was 69% (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocutaneous fistula induced by the stent and three patients with urethral hyperplasia. The mean follow-up duration was 8.4 months.ConclusionsOur initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent urethral stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile urethral stricture can be factors predicting poor results.

The Long-term Effect of Uretral Dilatation Therapy Combined with Steroid After Internal Urethrotomy

Objective: To present the long-term results of hydrophilic dilatation catheter or steroid-coated hydrophilic dilatation catheter usage in the management of primary urethral stricture. Methods: Forty-one male patients with a diagnosis of primary urethral stricture shorter than 1.5 cm and no comorbities were included in this study. After application of internal uretrotomy, these patients were randomized into two groups. A steroid-coated (triamcinolone acetonide (1%) 18F hydrophilic dilatation catheter was applied to the patients in group 1 for 2 weeks and an 18F hydrophilic dilatation catheter was applied to the patients in group 2 for 2 weeks, and catheters were removed after 3 days. Uroflowmetry and recurrence rate was used in postoperative follow-ups. Results: Mean patient age were respectively 45.1±8.0 and 47±8.8(68-29) years. Urethral stricture length was evaluated for group 1 7.4±4.0 mm and group 2 7.8±4.3 mm p:0.79. All patients uroflowmetry value (Q max) were followed up on 6,12,24 and 36 month and results were evaluated. Recurrence of urethral stricture was determined in 3 (13%) patients in group 1, and 3 (15%) patients in group 2 (p<0.05) and statisticaly significant. Conclusions: As an adjuvant treatment, this method is effortless, low in complications, and hopeful. Certainly, application to larger patient populations is needed to objectively accept its efficiency.