Recurrent Urethral Stricture Research Articles

Incidence and Management of Lower Urinary Tract Symptoms After Urethral Stricture Repair.

Lower urinary tract symptoms (LUTS) after urethral stricture repair are not uncommon. Urgency has been reported in 40% of men and urge incontinence in 12% of men after anterior urethroplasty. De novo urgency and urge incontinence is seen in 9 and 5% of men, respectively, after urethroplasty. Once a complication of urethroplasty (such as recurrent urethral stricture or diverticulum) has been excluded as a cause, evaluation of LUTS in such patients should focus on differentiating bladder dysfunction (overactive bladder, underactive bladder), from other outlet obstruction (such as benign prostatic obstruction), dysfunctional voiding, or medical causes (such as nocturnal polyuria). Management of overactive bladder may include behavioural modification, physical therapy, anticholinergic and/or beta-3 agonist medications, intravesical onabolulinum toxin, sacral neuromodulation or peripheral tibial nerve stimulation. Definitive treatment for underactive bladder is limited. Treatment of benign prostatic obstruction may include alpha-blocker and/or 5-alpha reductase inhibitor medication, or surgery to cavitate the prostate. Minimally invasive prostatic procedures are also an option. Although management of LUTS for patients after urethral stricture repair can usually proceed similarly as for patients without prior history of urethral reconstruction, special consideration and alterations in management need to be made when instrumenting the urethra, as the urethral lumen may be narrower in these patients.

Evaluation of the Efficacy and Safety of Laser versus Cold Knife Urethrotomy in the Management of Patients with Urethral Strictures: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Introduction: Urethral strictures generate great morbidity. Two procedures have been described for their management - laser and cold knife techniques - which are still widely used. We aim to assess the safety and efficacy of laser versus cold knife urethrotomy. Materials and Methods: We conducted a systematic search of the literature using MEDLINE, EMBASE, LILACS and Cochrane databases and gray literature. Primary outcomes were urethral stricture recurrence, time-to-recurrence and complication rate. Secondary outcomes were quality of life and maximum urinary flow rate (Qmax). Data analysis was obtained using Review Manager 5.2. Results: Out of 137 publications, 4 articles were included in the meta-analysis. At 3 months, the recurrence rate was similar in both groups (0.55, 95% CI 0.18-1.66), but at 6 and 12 months, it was significantly lower in the laser urethrotomy group (0.39, 95% CI 0.19-0.81 and 0.44, 95% CI 0.26-0.75). The analysis of Qmax at 6 months post-intervention suggested a greater improvement in the laser urethrotomy group. A qualitative analysis showed that complications in both procedures were minor and infrequent. Conclusions: Laser urethrotomy has a lower recurrence rate at 6 and 12 months compared to cold knife urethrotomy. Complications in both procedures are minor and infrequent. Results should be interpreted cautiously, since they were evaluated only for a short term.

Post-Surgical Outcomes of Dorsolateral Onlay Urethroplasty

Background: The standard management of urethral strictures involving the anterior urethra is dorsal onlay buccal mucosa augmentation urethroplasty. This requires circumferential mobilisation of the urethra, which might cause ischemia of the urethra in addition to chordee. In this research, we managed the anterior urethral stricture, applying a dorsolateral onlay urethroplasty.Methodology: This prospective study was conducted in the Department of Urology, BIRDEM General Hospital& some private hospitals from July 2009 to June 2015, the outcomes of a total cases of 103 of one sided anterior dorsolateral onlay OMG Urethroplastywere assess and compared. Patients with anterior and recurrent urethral stricture more than 1 cm were included as study population. Urethrogram and Uroflowmetry were the mainstay of assessment. Success was defined as a maximum flow rate of>20 ml/sec., normal RGU, and/or urethroscopy. Poor outcomes were defined as the presence of obstructive urinary tract symptoms, Qmax <15 ml/sec., stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention.Result: Of the 103 patients, 97 had (94.2%) successful outcome and 6 (5.8%) were failure. Four failed cases underwent optical internal urethrotomy and two patients had persistent narrowing and they were managed by BMG Urethroplasty. Follow up period was 12 months on an average. In conclusion, it can be said thatthe preservation of one sided vascular supply to the urethra and its entire muscular and neurogenic support represent significantly towards perfecting the surgical technique of urethral reconstruction using a minimally invasive approach.Conclusion: In this study, we found it to be a technically feasible, easily adoptable and finally successful procedure.Anwer Khan Modern Medical College Journal Vol. 7, No. 2: Jul 2016, P 16-19

Experience with 32 Pelvic Fracture Urethral Defects Associated with Urethrorectal Fistulas: Transperineal Urethroplasty with Gracilis Muscle Interposition

Pelvic fracture urethral defects associated with urethrorectal fistulas are rare and difficult to repair. The aim of this study was to evaluate the efficacy of transperineal urethroplasty with gracilis muscle interposition for the repair of pelvic fracture urethral defects associated with urethrorectal fistulas. We identified 32 patients who underwent transperineal urethroplasty with gracilis muscle interposition to repair pelvic fracture urethral defects associated with urethrorectal fistulas. Patient demographics as well as preoperative, operative and postoperative data were obtained. Mean followup was 33 months (range 6 to 64). The overall success rate was 91% (29 of 32 cases). One-stage repair was successful in 17 of 18 patients (94%) using perineal anastomosis with separation of the corporeal body and in 12 of 14 (86%) using perineal anastomosis with inferior pubectomy and separation of the corporeal body. All 22 patients (100%) without a previous history of repair were successfully treated. However, only 7 of 10 patients (70%) with a previous history of failed urethroplasty and urethrorectal fistula repair were cured. Recurrent urethral strictures developed in 2 cases. One patient was treated successfully with optical internal urethrotomy and the other was treated successfully with tubed perineoscrotal flap urethroplasty. Recurrent urethrorectal fistulas associated with urethral strictures developed in an additional patient. Transperineal urethroplasty with gracilis muscle interposition is a safe and effective surgical procedure for most pelvic fracture urethral defects associated with urethrorectal fistulas. Several other factors may affect its postoperative efficiency.

Analysis of recurrent urethral strictures due to iatrogenic urethral trauma

Background/aim: We aimed to analyze the effects of stricture location, etiology, age, and catheterization time on recurrence rate and recurrence time in patients who underwent direct vision internal urethrotomy (DVIU) for urethral strictures. Materials and methods: Patients were divided into three groups according to the location of the stricture: penile urethra, membranous urethra, and prostatic urethra strictures. Patients were also divided into three groups according to etiologic factors: strictures secondary to endoscopic procedures, urethral catheterization, and open or radical prostatectomy (anastomotic strictures were included in this group). Patients were also divided into three groups according to catheterization time: <2, 2-5, and >5-7 days. Recurrence rate and time data were analyzed according to stricture location, etiology, age, and catheterization time. Results: The recurrence rate was significantly higher in endoscopic procedures. Recurrence rate was significantly lower and recurrence time was significantly earlier in penile urethral strictures. Recurrence rate was significantly lower and recurrence time was significantly longer in short catheterized group than in the other two groups. However, first recurrence time was not different between the groups, while second and multiple recurrence times were significantly earlier in patients <60 years old.Conclusion: Patients are exposed to multiple operations as a result of frequently recurring urethral strictures. Although DVIU is an important first-line treatment method for strictures, alternative methods should be considered for frequently recurring cases.

Bone Marrow Stem/Progenitor Cells Attenuate the Inflammatory Milieu Following Substitution Urethroplasty.

Substitution urethroplasty for the treatment of male stricture disease is often accompanied by subsequent tissue fibrosis and secondary stricture formation. Patients with pre-existing morbidities are often at increased risk of urethral stricture recurrence brought upon in-part by delayed vascularization accompanied by overactive inflammatory responses following surgery. Within the context of this study, we demonstrate the functional utility of a cell/scaffold composite graft comprised of human bone marrow-derived mesenchymal stem cells (MSC) combined with CD34+ hematopoietic stem/progenitor cells (HSPC) to modulate inflammation and wound healing in a rodent model of substitution urethroplasty. Composite grafts demonstrated potent anti-inflammatory effects with regards to tissue macrophage and neutrophil density following urethral tissue analyses. This was accompanied by a significant reduction in pro-inflammatory cytokines TNFα and IL-1β and further resulted in an earlier transition to tissue remodeling and maturation with a shift in collagen type III to I. Grafted animals demonstrated a progressive maturation and increase in vessel size compared to control animals. Overall, MSC/CD34+ HSPC composite grafts reduce inflammation, enhance an earlier transition to wound remodeling and maturation concurrently increasing neovascularization in the periurethral tissue. We demonstrate the feasibility and efficacy of a stem cell-seeded synthetic graft in a rodent substitution urethroplasty model.

Comparative Assessment of Cultures from Oral and Urethral Stem Cells for Urethral Regeneration

Urethral reconstruction has received much attention in recent years, due to pathologies such as recurrence of urethral strictures after treatments. Various surgical techniques have been developed to obtain the best risk-benefit ratio, such as autologous grafts taken from the oral cavity. Tissue engineering and stem cells, growing in a tissue from a small biopsies, can further improve surgery, reducing invasiveness and morbidity. To determine whether urethra or other epithelia can be equally useful for urethra engineering, a comparison of clonogenic ability, proliferative potential and stem cell markers should be obtained. In this study, 19 biopsies from urethra, and 21 from oral mucosa were obtained from patients, during reconstructive surgery. Urethral and oral tissues were removed from the same donor, to develop primary cultures and cell characterization. The long term regenerative properties of both tissues were investigated in vitro by life span, clonal analysis and markers of different clonal types. Results revealed the same high proliferative potential for urethra and oral mucosa cultures, but maintenance of specific markers. Karyotype and growth factor dependence confirmed the normal phenotype of cultured cells. Clonal analysis of the proliferative compartment highlighted a very different proportion of stem and transient amplifying cells, characterised by dissimilar cell size profile and marker expression. In conclusion, both tissues can be cultured and preserve their stem cells in vitro. Few differences appeared in oral mucosa vs urethra, suggesting that they can be equally useful for tissue engineering of the urethral tract.

Female urethral stricture: a contemporary series.

To report the etiology, presenting symptoms and outcomes of the different treatments performed in female patients with recurrent urethral stricture. Twenty-six patients with refractory LUTS were diagnosed with a urethral stricture. The symptoms, the treatment performed and the outcomes were prospectively recorded. Sixteen patients were treated with a urethroplasty using a buccal mucosal graft (BMG) in 14 cases (54%) and a vaginal flap in 2 (8%). Urethral dilatation, optical urethrotomy and meatoplasty were performed in 8 (31%), 1 (3.8%) and 1 (3.8%) patients, respectively. Strictures were idiopathic in 11 patients (42%). Previous urethral instrumentation and traumatic vaginal delivery were the commonest causes of urethral stricture (42 and 15%, respectively). The most frequent symptoms were reduced flow (93%), detrusor overactivity (50%) and UTIs (42%). The stricture was cured in 93% of patients treated with a BMG urethroplasty and in all the patients in which a vaginal flap urethroplasty was performed. In the same group, the improvement in urethral pain was observed in the 67 and the 88% of patients were cured from recurrent UTIs. All the patients treated with urethral dilatation needed further dilatations; hence, the cure of the stricture was achieved in none of them. Improvement in urethral pain, UTIs and detrusor activity was not recorded in the latter group. Urethroplasty in its various forms has demonstrated in the present series the highest cure rate for the treatment of recurrent urethral stricture.

Management of 220 adolescents and adults with complications of hypospadias repair during childhood

ObjectiveThe goal of hypospadias repair is to achieve normal voiding and good penile cosmesis with minimal complications. Some urethroplasties deteriorate from childhood to adolescence and late stage failures have been reported. We report our experience with adult patients who have had a previous repair during childhood and present with a late complication. MethodsWe reviewed the records of 220 patients aged 15–39 years old with a history of hypospadias repair who presented to our clinic. Forty-five patients with chordee, 39 with urethral strictures, 11 urethral fistulae, five with hairy urethras, three with urethral diverticula, and 117 patients with an abnormal glans or subterminal meatus were repaired. ResultsMedian follow-up was 14 months. Two patients had persistent chordee. Island skin flap urethroplasty afforded one patient with a urethral fistula and another with a recurrent urethral stricture, while the buccal mucosa group had one fistula which healed spontaneously and two recurrent strictures. For the patients undergoing glanular repairs, seven had dehiscence or breakdown of the repair. All other operations were successful. ConclusionComplications of childhood hypospadias repair may present later in life as some urethroplasties deteriorate with time. We now recommend to parents of children with repaired proximal hypospadias to come for follow-up as their child transitions to adolescence.

Prevention of stricture recurrence following urethral internal urethrotomy: routine repeated dilations or active surveillance?

Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. Currently, routine repeated dilations, including intermittent self-catheterisation (ISC) are prescribed by urologists to prevent urethral stricture recurrence. There is, however, no high level evidence available supporting the effectiveness of practicing these painful techniques. Balancing efficacy, adverse effects and costs, we hypothesize that active surveillance is a better option for preventing stricture recurrence as compared with routine repeated dilations. However, well designed, adequately powered multi-center trials with comprehensive evaluation are urgently needed to confirm our hypothesis.&nbsp.

Predictors of urethral stricture recurrence after endoscopic urethrotomy

ObjectiveThe aim of the study was to analyze the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. Material and methodsWe retrospectively analyzed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included.We analyzed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and etiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations.A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. ResultsThirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), <1cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for <15 days (85.1%) and did not undergo postsurgical dilatation (65.7%).Only the length of the stricture was an independent risk factor for recurrence (p=.025; relative risk, 5.7; 95% CI 1.21–26.41). ConclusionsIn the treatment of urethral strictures through endoscopic urethrotomy, a stricture length >1cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterization time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary.

Editorial Comment

Editorial Comment

Factores predictivos de recidiva de estenosis uretral tras uretrotomía endoscópica

ObjectiveThe aim of the study was to analyse the clinical-demographic variables of the series and the predictors of urethral stricture recurrence after endoscopic urethrotomy. Material and methodsWe retrospectively analysed 67 patients who underwent Sachse endoscopic urethrotomy between June 2006 and September 2014. Those patients who had previously undergone endoscopic urethrotomy or urethroplasty were excluded. The other patients who presented urethral stricture were included.We analysed age, weight, smoking habit, and cardiovascular risk factors, as well as the number, location, length and aetiology of the strictures, previous urethrotomies, vesical catheter duration and postsurgical dilatations.A univariate and multivariate analysis was conducted using the chi-squared test or Fisher's test and logistic regression to identify the variables related to recurrence. ResultsThirty-seven percent of the patients had a relapse. The majority of the patients were older than 60 years (56.7%), obese (74.6%), nonsmokers (88%) and had no cardiovascular factors (56.7%). The majority of the strictures were single (94%), <1cm (82%), bulbar urethral (64.2%), iatrogenic (67.2%) and with no prior urethrotomy (89.6%). The majority of the patients carried a vesical catheter for <15 days (85.1%) and did not undergo postsurgical dilatation (65.7%).Only the length of the stricture was an independent risk factor for recurrence (P=.025; relative risk, 5.7; 95% CI 1.21-26.41). ConclusionsIn the treatment of urethral strictures through endoscopic urethrotomy, a stricture length >1cm is the only factor that predicts an increase in the risk of recurrence. We found no clinical or demographic factors that caused an increase in the incidence of recurrence. Similarly, technical factors such as increasing the bladder catheterisation time and urethral dilatations did not change the course of the disease. Their routine use is therefore unnecessary.

Editorial Comment

The Trauma and Urologic Reconstruction Network of Surgeons (TURNS) group conducted this study with the aim to show the ability of a noninvasive test to monitor for recurrence of stricture after urethroplasty, introducing a novel new evaluation tool Qmaximum-Qaverage (Qm-Qa). The authors conducted a well-designed, multi-institutional study with 323 men 1 Tam C.A. Voelzke B.B. Elliott S.P. et al. Critical analysis of the use of uroflowmetry for urethral stricture disease surveillance. Urology. 2016; 91: 197-202 Scopus (23) Google Scholar to compare this new tool with what in the past was considered the gold standard for testing for recurrent urethral stricture disease—cystoscopy. They included only patients who underwent very well-conducted and validated flow studies (those who had greater than 150 mL volume) and the surgeon interpreted every flow study personally, avoiding error introduced by computer interpretation.

The International Prostate Symptom Score (IPSS) Is an Inadequate Tool to Screen for Urethral Stricture Recurrence After Anterior Urethroplasty

To validate the use of the International Prostate Symptom Score (IPSS) as a stand-alone tool to detect urethral stricture recurrence following urethroplasty. This study included 393 men who had undergone anterior urethroplasty and were enrolled in a multi-institutional outcomes study. Data analyzed included pre- and post-operative answers to the IPSS in addition to findings from a same- day cystoscopy. IPSS from men found to have cystoscopic recurrence were then compared to scores from those with successful repairs, and receiver operating characteristic curves were plotted to illustrate the predictive ability of these questions to screen for cystoscopic recurrence. Mean postoperative scores were lower (fewer symptoms) in successful repairs; IPSS improved from preoperative values regardless of recurrence. Successful repairs had significantly better degree of improvement in question #5 (assessing weak stream) compared to recurrences. Receiver operating characteristic curves demonstrated the highest area under the curve for the IPSS quality of life question (0.66) that alone outperformed the complete IPSS questionnaire (0.56). The IPSS had inadequate sensitivity and specificity to be used as a stand-alone screening tool for stricture recurrence in this large cohort of men, highlighting the need to continue development of a disease-specific, validated patient-reported outcome measure.

Application of vascularized tunica vaginalis flap technique in repairing recurrent urethrocutaneous fistula following hypospadias surgery

0bjective To investigate the feasibility and efficacy of tunica vaginalis flap cover in treatment of recurrent urethrocutaneous fistula (UCF). Methods We reviewed the clinical datas of 25 cases of UCF after urethroplasty of hypospadias from January 2011 to January 2015. The mean age of the patients was 6.2 years(range 1.6 -14.0 years). All patients had undergone previous hypospadias repair and at least one previous failed attempt to close the urethrocutaneous fistulae. There were 5 cases of fistula in the coronary sulcus, 6 cases of fistula in the penile body and 14 cases of fistula at the junction of penis and scrotum.The diameter of urethrocutaneous fistulae were 3-10 mm. Single fistula was present in all patients. 16 cases had undergone UCF repair for two times, 9 cases had undergone UCF repair for more than two times. After closing the fistula with inverting running stitch, a tunica vaginalis flap was mobilized to cover the repair site through a subcutaneous tunnel and the skin closed. Results The mean follow-up time was 2.1 years(range 0.5- 4 years). The overall success rate was 96%(24/25). Penile cosmesis was excellent. There was no evidence of recurrent fistulas or urethral strictures. All parents reported a straight penis when erected, and one patient in whom there was leak from the fistula site because of local wound infection. No postoperative complication was encountered in the testis. The testis was of normal size and position, and the ultrasound findings were normal. Conclusions Repairment of recurrent urethrocutaneous fistulas with a tunica vaginalis flap could be effective regardless of fistula location. The technique is simple to improve the success rate of the repair of UCF effectively and reduce the occurrence of postoperative complications. Key words: Vascularized tunica vaginalis flap; Hypospadias; Urethrocutaneous fistula

Comparative evaluation of the different types of open urethroplasty in long stricture and obliteration of the urethra

Objective: to conduct a comparative assessment of the effectiveness of different types of open urethroplasty in long strictures and obliteration of the urethra. Materials and methods. The results of open urethroplasty in 68 patients for the period 2003–2015 years were reviewed retrospectively. These patients divided into 4 groups: 1st – augmentation buccal mucosa urethroplasty (BMU) – 11 (17,0%), 2nd uretro-urethroor urethro-prostatоanastomosis – 39 (53,0%), 3rd – substitution skin and fascial flap urethroplasty – 8 (13,0%), 4th – substitution BMU – 10 (17,0%). Results. The average length of strictures was in 1st gr. – 2,2±0,1 sm; 2nd gr. – 3,3±0,8 sm; 3rd gr. – 3,3±0,9 sm аnd 4th gr. – 5,3±0,8 sm. Тhe average length of recovery independent of urination was: 1st gr. – 19,3±0,7, 2nd gr. – 16,6±0,7, 3rd gr. – 19,4±1,6 and in 4th gr. – 17,1±1,1 days. Complications in the early recovery period (30 days) were: acute urinary retention – 4 (5,9%) observations, orhoepidydymitis – 5 (7,4%), fistula perinealis – 3 (4,4%). The recurrence of urethral stricture in long-term follow-up we observed in 6 (8,8%) patients, but erectile dysfunction – in 18 (26,5%). Conclusions. Good result noted in 65 (91,2%) patients, bad results – in 3 (4,4%), doubtfull results – in 3 (4,4%). The overall effectiveness was – 95,6%, with a mean follow-up – 9,8±2,3 months.

MP52-11 CAN HISTOPATHOLOGICAL DIAGNOSIS OF LICHEN SCLEROSUS IN PATIENTS WITHOUT CLINICAL FINDINGS PREDICT URETHRAL RECONSTRUCTION OUTCOMES?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2016MP52-11 CAN HISTOPATHOLOGICAL DIAGNOSIS OF LICHEN SCLEROSUS IN PATIENTS WITHOUT CLINICAL FINDINGS PREDICT URETHRAL RECONSTRUCTION OUTCOMES? Oscar A. Storme, Jeremy B. Tonkin, Jefferson Lin, Ramón Virasoro, Jack M. Zuckerman, Jessica M. DeLong, and Kurt A. McCammon Oscar A. StormeOscar A. Storme More articles by this author , Jeremy B. TonkinJeremy B. Tonkin More articles by this author , Jefferson LinJefferson Lin More articles by this author , Ramón VirasoroRamón Virasoro More articles by this author , Jack M. ZuckermanJack M. Zuckerman More articles by this author , Jessica M. DeLongJessica M. DeLong More articles by this author , and Kurt A. McCammonKurt A. McCammon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.487AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lichen Sclerosus (LS) is a chronic, progressive mucocutaneous inflammatory condition, that causes destructive urethral strictures. The etiology of this condition is unknown. Urethral strictures secondary to this condition are usually suspected by clinical genital exam and confirmed by biopsy, but in many centers of urethral reconstruction, pathologist usually inform only the presence or not of cancer. We reviewed urethral biopsies of patients without clinical findings of LS who received anterior urethroplasty, looking for non-diagnosed LS and correlation with urethral stricture recurrence. METHODS Retrospective chart review of all adult men with anterior urethral strictures that underwent urethroplasty between January 1, 2010 and August 1, 2014. Patients without clinical findings of LS were included. Stricture biopsies were reviewed by a single uropathologist, looking for hyperkeratosis, epidermal thinning or thickening, basal cell vacuolar degeneration, lichenoid lymphocytic infiltrate and subepithelial hyalination. Patients with 0 or 1 feature were considered negative for LS, patients with 2 features were considered suggestive of LS and patients with 3 or more features were considered diagnostic for LS. Data collection included: demographics, preoperative evaluation, urethral stricture recurrence. Recurrence was defined as the requirement of any treatment for the stricture. We analyzed categorical data with chi2, continuous descriptive data statistical analysis was carried out using Graphpad software. Statistical significance p value was considered with < 0.05. RESULTS Ninety-one patients, mean age 49,3 years (SD: +/-14.98), were included. Mean stricture length was 4.158 (SD: +/-3.08). Stricture location was bulbar in 65 patients (71.4%), panurethral 20 (21.9%) and pendulous in 6 (6.6%). Biopsies were negative for LS in 43 patients (47.3%), suggestive of LS in 26 (28.6%) and positive for LS in 22 patients (24,2%). After a mean follow-up of 18.32 months (SD: +/-14.9). Three patients (3.2%) without LS and 3 patients with LS presented recurrence (p=0.3985). CONCLUSIONS Lichen sclerosus was present in an important number of patients who underwent anterior urethroplasty. In this series there is no relation between presence of LS and urethral stricture recurrence. We consider that urethral biopsy must be done in patients with anterior urethral strictures looking for LS presence specially if a skin flap is considered as surgical approach. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e693 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Oscar A. Storme More articles by this author Jeremy B. Tonkin More articles by this author Jefferson Lin More articles by this author Ramón Virasoro More articles by this author Jack M. Zuckerman More articles by this author Jessica M. DeLong More articles by this author Kurt A. McCammon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD16-02 VARIABLE DEFINITIONS OF URETHRAL STRICTURE RECURRENCE AFTER VISUAL INTERNAL URETHROTOMY AND URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2016PD16-02 VARIABLE DEFINITIONS OF URETHRAL STRICTURE RECURRENCE AFTER VISUAL INTERNAL URETHROTOMY AND URETHROPLASTY Benjamin A Sherer, M. Ryan Farrell, Fahad Chaus, and Laurence A Levine Benjamin A ShererBenjamin A Sherer More articles by this author , M. Ryan FarrellM. Ryan Farrell More articles by this author , Fahad ChausFahad Chaus More articles by this author , and Laurence A LevineLaurence A Levine More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1154AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Experts and international panels have called for uniformity in defining “recurrence” after urethroplasty for urethral strictures based on data prior to 2010. We evaluated how urethral stricture recurrence after both urethroplasty and visual internal urethrotomy (VIU) is being evaluated and defined in subsequent contemporary series. METHODS We performed a systematic review of all studies reporting outcomes of either VIU or urethroplasty from 2009-2014. A PubMed/Medline search was performed using the terms urethroplasty, internal urethrotomy, and recurrence. Studies reporting number of patients treated, follow-up period, follow-up methods, and definition of stricture recurrence were included for review. RESULTS Among 39 contemporary studies meeting inclusion criteria (Urethroplasty n=26, VIU n=13) definitions of recurrence fell into 5 major categories: Need for repeat procedure/instrumentation (Urethroplasty 50.0%, n=13; VIU 15.4%, n=2; Overall 38.5%, n=15), inability to pass a cystoscope (16-18Fr or not specified) (Urethroplasty 26.9%, n=7; VIU 7.7%, n=1; Overall 20.5%, n=8), decreased Q max on uroflowmetry (Urethroplasty 7.7%, n=2; VIU 38.5%, n=5; Overall 17.9%, n=7), stricture visible on ultrasound (Urethroplasty 3.8%, n=1; VIU 0%, n=0; Overall 2.6%, n=1), or a combination of aforementioned modalities (Urethroplasty 11.5%, n=3; VIU 38.5%, n=5; Overall 20.5%, n=8). Of the combined modalities, 4 involved the presence of subjective symptoms. Overall, among the 39 studies, there were 18 unique definitions of stricture recurrence reported. Timing, frequency, and duration of follow-up also varied widely. CONCLUSIONS There remains wide variability in the reporting of outcomes after treatment of urethral strictures with urethroplasty or VIU. This makes any direct or longitudinal comparison between studies difficult. There is an ongoing need to establish uniform parameters for evaluating outcomes and defining urethral stricture recurrence after surgical intervention. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e394 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Benjamin A Sherer More articles by this author M. Ryan Farrell More articles by this author Fahad Chaus More articles by this author Laurence A Levine More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Outcomes for Management of Lichen Sclerosus Urethral Strictures by 3 Different Techniques

To evaluate the intermediate-term outcomes from a large, single institution series of patients with lichen sclerosus (LS) who underwent surgical management of their urethral strictures. We retrospectively reviewed 79 patients who underwent surgical management of their LS urethral strictures from 2003 to 2014, comparing outcomes of patients undergoing a single-stage buccal mucosa graft (BMG) urethroplasty, 2-stage BMG urethroplasty, or perineal urethrostomy (PU). Demographic and surgical outcomes data were collected for all patients. Of the 79 patients, the mean follow-up was 32.4 months, mean age was 50.1 years, and the mean body mass index was 35.7, with morbid obesity (body mass index > 35) in 48% of the cohort. The mean stricture length was 9.6 cm (1.5-21 cm), with 62% of patients having a bulbopendulous stricture. Of the 37 patients who were planned for a 2-stage BMG urethroplasty, 9 (24%) patients had stricture recurrence or recurrent LS in the first-stage BMG. Single-stage BMG urethroplasty was performed in 20 patients with a mean stricture length of 9.47 cm (4-21 cm) and a success rate of 75%. Fourteen patients from the cohort received a PU as the primary treatment, with a success rate of 93%. Management of LS strictures continues to pose challenges to the reconstructive surgeon due to the high rate of stricture recurrence and often progression. Patients undergoing single-stage or 2-stage reconstruction often require revision and must be carefully observed for recurrent urethral stricture. PU offers the highest degree of success and should be considered for all patients.