Short Segment Bulbar Urethral Stricture Research Articles

Role of magnetic resonance urethrography in evaluation of male urethral stricture

Background: Urethral stricture in male is a common urological disease causing lower urinary tract symptoms like thin stream of urine with straining to urinate, may be associated with dysuria or acute urinary retention. RGU is gold standard in male urethral stricture evaluation. In this study we compare magnetic resonance urethrography (MRU) with retrograde urethrography (RGU) in diagnosing male urethral stricture. Methods: The 40 male patients with the diagnosis of stricture urethra were taken for this study. Evaluation done first by RGU then after 7 days MRU. Final corroboration of above findings with the surgery (endoscopic or open). Results: Data of 40 male patients with urethral stricture are analysed with computer software SPSS v 25. mean age of stricture diagnosis is 43 years (range is 31-63 years). Mean length of stricture is 1.90 cm (with SD 0.85), 1.89 cm (with SD 0.92) and 1.91 cm (with SD 0.94) in RGU, MRU and Surgery respectively. sensitivity and specificity of RGU is 84.2% and 50% and MRU is 92.1% and 100% respectively. accuracy of RGU and MRU is 82% and 92% respectively. 3 patients out of 16 patients with long segment bulbar urethral stricture (>1.5 cm) without any spongiofibrosis managed with BMG urethroplasty. Two patients out of 24 patients with short segment bulbar urethral stricture (<1.5 cm) with dense spongiofibrosis managed with PEEAU. Conclusions: Both RGU and MRU can detect stricture lengths accurately but MRU has advantage of detection of spongifibrosis in cases of anterior urethral stricture. MRU detects orientation and alignment of both proximal and distal urethral segments in case of PFUI.

Is testosterone deficiency a predictive factor for recurrence of urethral stricture?

Testosterone plays a vital role in maintaining tissue homeostasis, and testosterone deficiency may potentially influence the likelihood of urethral stricture recurrence. To evaluate the prognostic value of testosterone levels in the recurrence after direct visual internal urethrotomy in primary short segment bulbar urethral strictures and its clinical reflections. A total of 723 patients who underwent direct vision internal urethrotomy between January 2000 and October 2022 were retrospectively analyzed. After implying exclusion criteria, 116 patients with available data were enrolled. Patients were divided into two groups as recurrence and no recurrence. Age, stricture length, etiology, time of recurrence, diagnosis of previous diabetes mellitus, hypertension, smoking, body mass index, and total testosterone levels were recorded. Free testosterone and bioavailable testosterone values were calculated using total testosterone, albumin, and sex hormone binding globulin values. Hypogonadism was considered as a total testosterone level less than 300ng/dL. Demographic characteristics and total testosterone, free testosterone, and bioavailable testosterone levels were compared between the two groups for statistical significance. The recurrence rates of patients with and without hypogonadism were compared. Recurrence was observed in 41.4% of the cases (n=48). There was no statistically significant difference between the groups in terms of age, body mass index values, diabetes mellitus, hypertension, smoking status, presence of hypogonadism, and etiology (p=0.745, 0.863, 0.621, 0.622, 0.168, 0.051, and 0.232). In terms of total testosterone levels and bioavailable testosterone levels, the recurrence group had significantly lower values (p=0.018 and 0.04). There was no significant difference between the two groups in terms of stricture length (p=0.071). Sixteen of 28 patients with hypogonadism had recurrence, whereas 32 of 88 patients without hypogonadism had recurrence (p=0.051). Testosterone levels have potential to predict recurrence in primary short-segment bulbar urethral strictures. This study represents the inaugural analysis of the impact of testosterone deficiency on recurrence within the cohort of patients with primary short-segment bulbar urethral strictures. Testosterone levels and ratios may serve as predictive factors for identifying recurrent cases in primary short-segment bulbar strictures. For patients at a higher risk of recurrence, urethroplasty may be considered as an initial treatment option, even in cases of primary and short-segment strictures.

Holmium laser versus cold knife visual internal urethrotomy for management of short segment urethral stricture: a prospective randomized clinical trial

ObjectivesTo report the safety and efficacy of holmium laser and compare its results with cold knife visual internal urethrotomy (VIU) in the management of short segment urethral stricture.MethodsThis prospective randomized study included 66 male patients aged more than 18 years, with short segment bulbar urethral strictures < 2 cm from March 2020 to March 2022. The patients were randomized into two groups each containing 33 patients. In group A (Cold knife group), Sachse cold knife was used for stricture treatment. In group B (Holmium group), internal urethrotomy was done with Ho:YAG laser. Patients were evaluated before the operation and followed up after the operation at 1, 3, 6 and 12 months by physical examination, IPSS, PVR, Qmax and retrograde urethrography.ResultsThere was significant improvement in the mean values of IPSS, PVR and Qmax in both groups. There was no significant difference between both groups in the mean values of IPSS, PVR and Qmax during follow-up visits. However, at the end of follow-up at one year there was statistically significant difference between both groups in the mean values of IPSS, PVR and Qmax due to higher recurrence rate in cold knife group than laser group. The overall complication rate is significantly lower in laser group (p = 0.014).ConclusionHolmium laser VIU is an effective and safe treatment option for short segment urethral stricture with shorter operative time, less complication rate and less recurrence than cold knife VIU.

Prevalent Practices in Male Anterior Urethral Stricture Management: A Survey

Objective: This article aimed to study the prevalent practices in the treatment and follow-up of urethral strictures. Moreover, the article aimed to investigate the present opinion among urologists as the treatment practices for urethral stricture disease are mostly dependent on the treating surgeon’s expertise and preference in the absence of widely followed standard guidelines. Methods: A questionnaire was formulated based on the responses from experts. From October to December 2020, all members of the urological society of India received a mailed questionnaire on a web-based survey platform. Practicing urologists from across the country are among its members. Results: A total of 2554 urologists were contacted by mail, and 282 (11%) urologists provided a response. The majority were doing 5 to 15 urethroplasties a year. A newly diagnosed short segment bulbar urethral stricture would be a candidate for a visualized internal urethrotomy (VIU), according to 69.5% of urologists. Recurrence after one attempt at VIU prompted 80% to switch to urethroplasty as the next choice. During preoperative evaluation, 100% of respondents wanted a retrograde urethrogram, 74% deemed micturating cystourethrogram necessary, and 60% wanted a urethroscopy. At discharge, the majority preferred silicone Foley catheters, and the preferred size was 16F (54%). The patients were discharged with both suprapubic catheter and Foley in situ by most urologists. During follow-up, 60.99% wanted uroflowmetry, and the duration of follow-up varied. Conclusion: This survey on urethral stricture management amongst urologists shows that there is wide variation in the management of stricture urethra. This survey underscores the need for large-scale, long-term studies to formulate a guideline for the management of urethral stricture disease, thereby bringing uniformity in the care provided.

Direct Visual Internal Urethrotomy in Supine Position in a Patient with Complex Deformities of Both Lower Limbs and Neurogenic Bladder: A Case Report

Direct visual internal urethrotomy (DVIU) is a minimally invasive treatment for urethral stricture and is usually done in lithotomy position. We presented a case of a 35-year-old man with complex deformities of both lower limbs from birth. The lower limbs were severely wasted with ankylosis of the hips, flexion of the knee joints and dorsiflexion at the ankle joints. He had a history of progressively worsening difficult in urination characterized by frequency, urgency, urgency incontinence, nocturia, poor urinary stream (improved by straining), intermittency and feeling of incomplete bladder emptying. He had occasional dysuria and total hematuria. He was not a known hypertensive or diabetic patient. No history of trauma, previous urethral instrumentation, and no history of purulent urethral discharge before the onset of problems. On presentation, his abdomen was full with slight suprapubic distention. The anal sphincter was spastic and the prostate was not enlarged. He had normal non-circumcised male external genitalia. There was no spinal deformity and the upper limbs were normal. White cell count was 14,000 cells/ mm3 with a differential neutrophil of 85.5% and urine culture showed moderate growth of coliforms. Abdominopelvic ultrasound showed a thickened bladder wall with mild hydronephrosis bilaterally and a retrograde urethrography and micturating cystourethrography showed 3 short segment bulbar urethral strictures. There was also a Christmas tree appearance of the bladder. A diagnosis of bladder outlet obstruction secondary to multiple short segment idiopathic bulbar urethral strictures on background neurogenic bladder was made. He had intravenous antibiotics for 48 hours and subsequently a DVIU under spinal anesthesia and in the supine position. Catheter was removed on the 7th day post procedure and he started clean intermittent catheterization (CIC) with 12 French catheters. Seven months post procedure, patient is still satisfied with the outcome of his treatment. We concluded that DVIU can be done safely in the supine position and CIC can help improve post procedure outcome and in managing comorbid neurogenic bladder.

Outcome of Anastomotic Urethroplasty for Bulbar Urethral Stricture Our Experience

Objective: For evaluation of patients who underwent bulbar end-to-end anastomosis to assess surgical outcome.&#x0D; Materials and Methods: We reviewed 53 patients with an average age of 44 years who underwent bulbar end-to-end anastomosis from January 2013 to July 2018. A total of 9 patients (16.98%) underwent urethrotomy, dilation, or multiple treatments before referral to our center. Stricture length d”2cm, free from infection and completed at least 6 months of follow up were included. Patients were evaluated post operatively by uroflowmetry at 3, 6, 12 months of follow up and yearly thereafter. Clinical outcome was considered a treatment failure when any postoperative instrumentation was needed.&#x0D; Results: Mean age 44 (SD±7.6, range 33 to 54 years). Stricture etiology was blunt perineal trauma 32 (60.37%), infection 12(22.64%), idiopathic 06(11.32%) and iatrogenic 03(05.67%). Mean operation time was 95 minutes (range, 50 to 140 minutes) and mean excised stricture length was 1.4 cm (range, 0.5 to 2 cm). 44 patients (83.02%) were symptom-free and required no further procedure. Strictures recurred in 9 patients (16.98%) within 2 to 5 months after surgery. Of 9 recurrences, 3 patient was managed successfully by urethrotomy, whereas the remaining 6 did not respond to urethrotomy or dilation and required additional urethroplasty.&#x0D; Conclusions: Excision and end-to-end anastomosis urethroplasty is an excellent procedure for short segment bulbar urethral stricture.&#x0D; Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.56-61

Outcome of Optical Internal Urethrotomy and Anastomotic Uretrhoplasty for Short Segment Bulbar Urethral Stricture

Background: Urethral stricture diseases are common urological problems in our country. The etiologies include iatrogenic, trauma, infection, congenital and very few are idiopathic. Urethral strictures have the potential for great negative impact on patients. These have several treatment modalities, ranging from simple dilations to complex multistaged urethroplasties. Optical internal urethrotomy and anastomotic urethroplasty are the common procedures among them which are particular topics in this study.&#x0D; Objectives: To evaluate the outcome of two surgical techniques- Optical Internal Urethrotomy (OIU) and Anastomotic Urethroplasty.&#x0D; Methodology: A total of 50 patients with short segment bulbar urethral strictures were consecutively included in the study. Purposive sampling method was applied. The present outcome clinical study was conducted in the department of Urology, National Institute of Kidney Diseases and Urology, Sher-E-Bangla Nagar, Dhaka, Bangladesh over a period of 1 year from February 2016 to January 2017. Student’s t-test and chi-square test were applied for hypothesis testing. ‘P’ value &lt;0.05 was considered as significant.&#x0D; Result: There is no significant difference between two groups regarding age, history of previous operation for stricture urethra, mode of clinical presentations before intervention, immediate post-operative complication and uroflowmetry during follow-up. But length of stricture of two groups, urinary stream at 3 and 6 months after operation, urinary tract infection at 6 month after operation, recurrence of stricture in two groups were statistically significant (p&lt;0.05).&#x0D; Conclusion: The study concluded that anastomotic urethroplasty was an effective and satisfactory technique for the treatment of short segment bulbar urethral stricture. The morbidity and complications were low and outcomes were excellent.&#x0D; Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.30-35

Buccal Mucosal Graft Urethroplasty as Primary Repair Has Significantly Better Outcome Than After Failed Dviu Cases- a Clinical Trial

Introduction: Direct Visual Internal Urethrotomy (DVIU) is the most commonly used technique for short segment bulbar urethral stricture till date. But it has a high failure and recurrence rate. On the other hand, urethroplasty is regarded as the gold standard treatment for urethral stricture. Moreover, for bulbar urethral stricture, usually more than 3cm stricture are treated with substitution urethroplasty. Current practice for short segment bulbar urethral stricture is multiple sessions of DVIU and then buccal mucosal graft (BMG) urethroplasty if they fail. But repeated DVIU make the stricture segment longer and more fibrotic. Considering the morbidities following repeated DVIU, this prospective clinical trial has been designed to compare the outcome of BMG urethroplasty after failed urethrotomy versus primary repair.&#x0D; Objective: To determine stricture recurrence, PVR and flow of urine in between primary BMG urethroplasty group and after failed DVIU group.&#x0D; Patients and Methods: The present study was conducted in the department of Urology, BSMMU between July’15 - February’17. Patients of short segment bulbar urethral stricture between 1.5- 3 cm without any previous DVIU were enrolled as study group(n=22) and patients with history of failed DVIU were included as control group(n=22). All the patients were followed upto 12 months after BMG urethroplasty and recurrence of stricture (by RGU and MCU), PVR and maximum urine flow rate (Qmax) in between two groups were compared.&#x0D; Results: The stricture recurrence rate was found significantly higher in control group than in the study group (p=0.042). The study group showed highly significant (0.000) decrease in post-operative PVR and significant (0.009) increase in post operative maximum urine flow rate than the control group as was assumed in the hypothesis.&#x0D; Conclusion: The present study propose that BMG urethroplasty as primary repair for bulbar urethral stricture within a length of 1.5-3 cm in younger age group (upto 45 years ) is very effective than BMG urethroplasty after failed DVIU cases. But long term multicentric trial is needed to further comment.&#x0D; Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.3-7

Holmium laser vs cold knife – direct vision internal urethrotomy in management of bulbar urethral stricture

Objectives The aim was to compare the safety and efficacy of using Holmium: YAG laser vs the cold knife in the treatment of short-segment bulbar urethral stricture. Background Male urethral stricture is a common condition in urological practice. Cold knife urethrotomy is the most appealing therapeutic method among urologists, as it is an easy and minimally invasive endoscopic procedure. Patients and methods This is a randomized prospective study that was done on 60 patients divided into two groups: group A included 30 patients subjected to cold knife urethrotomy (direct VIU), and group B included 30 patients subjected to HO: YAG laser urethrotomy (laser VIU). Results After 6 months, the success rate was 77.8% with less than 1-cm stricture length of direct VIU cases vs 78.3% with less than 1-cm stricture length of laser VIU cases. On the contrary, it was 41.7% with stricture greater than 1 cm of direct VIU cases vs 42.9% with more than 1 cm stricture length of laser VIU cases. After 12 months, we had the same results obtained at 6 months. Conclusion Laser VIU by using Ho: YAG laser can be used as a method of treatment of this disorder. It is an effective, low-invasive technique, with results are comparable to those of cold knife (direct VIU).

Comparative Study Of Optical Internal Urethrotomy Versus Anastomotic Urethroplasty For Short Segment Bulbar Urethral Stricture

Objective: This study was conducted to compare the outcome of anastomotic urethroplasty with that of traditional optical internal urethrotomy in the treatment of short-segment bulbar urethral stricture.&#x0D; Methods: This comparative clinical study was conducted in the Department of Urology, Dhaka Medical College Hospital over a period 1 year from January 2007 to December 2008. A total of 50 patients with short-segment (&lt; 2 cm) bulbar urethral strictures were consecutively included in the study. The test statistics used to analyses the data were Fisher’s Exact Probability Test, Student’s t-Test. For all analytical tests, the level of significance was set at 0.05 and p &lt; 0.05 was considered significant.&#x0D; Results: About one-quarter (24%) of patients in OI Urethrotomy group experienced bleeding, 4% epididymitis and another 4% incontinence. In contrast, 8% of patients in Anastomotic Urethroplasty group complained of periurethral leakage, 8% fever and another 8% wound infection. Apart from bleeding, all the complications were almost homogeneously distributed between groups.Six (24%) of patients in OI Urethrotomy Group exhibited narrow urinary stream at month 3, as opposed to none in Anastomotic Urethroplasty Group (p = 0.001). Nearly 30% of patients in OI Urethrotomy Group had narrow urinary stream at month 6 compared 4% in Anastomotic Urethroplasty Group (p = 0.024). Of the 25 patients in OI Urethrotomy Group, 1(4%) developed UTI at month 3 and 5(20%) at month 6. None of the patients in Anastomotic Urethropasty Group developed UTI. There was significant difference between groups in terms of UTI at month 6 (p = 0.025).The recurrence rate of stricture in OI Urethrotomy was 24% (6 out of 25 patients) at month 3. However, none in Anastomotic Urethroplasty Group had history of recurrence of stricture (p = 0.011). At baseline the mean uroflowmetry was 5.5 ml/sec in both groups which immediately increased to 25.3 ± 2.6 ml/sec and 23.9 ± 2.2 ml/sec in OI urethrotomy and Anastomotic Urethroplasty groups respectively and then dropped to 18.4 ± 6.3 ml/sec and 20.2 ± 2.6 ml/sec in OI Urethrotomy and Anastomotic Urethroplasty groups respectively at month 3 and to 17.8 ± 6.4 ml/sec and 19.6 ± 2.6 ml/sec respectively at month 6.&#x0D; Conclusion: This study concludes that Anastomotic Urethroplasty is an effective and satisfactory technique for the treatment of short-segment bulbar urethral stricture.&#x0D; Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2013 p.21-25

An audit of management of male urethral stricture and it’s outcome: a single centre retrospective review

Background: Anterior urethral stricture involves penile, bulbar or panurethra with varied aetiology. Direct vision internal urethrotomy (DVIU), stricture excision with primary end to end anastomosis, single stage or staged reconstruction with local flap or buccal mucosal graft (BMG) are surgical options.Methods: This single centre retrospective study was conducted from April 2017 to March 2019. Patient underwent DVIU, stricture excision with primary end to end anastomotic, staged urethroplasty, BMG urethroplasty (BMGU) dorsal inlay Asopa technique, dorsal onlay Kulkarni technique and ventral onlay technique depending on site and extent of strictures. Preoperative, intraoperative, post-operative data were reviewed.Results: Here, 51 patients underwent DVIU for single soft short segment bulbar urethral stricture with success rate 58.82%. 26 patients with post traumatic short segment bulbar urethral stricture underwent excision and primary end to end anastomosis with success rate 92.31%. Patients with long segment bulbar urethral stricture underwent either dorsal onlay (n=19) or ventral onlay (n=14) BMGU with success rate 89.47% and 85.71% respectively. Total 59 patients with long segment penile or pan urethral stricture underwent either single stage (n=27) or staged reconstruction (n=32) with success rate of 85.18% and 90.63% respectively. Patients with staged reconstruction had significantly longer hospital stay (p&lt;0.0001) and poor quality of life due to laid opened urethra. Asopa’s dorsal inlay (n=15) and Kulkarni’s dorsal onlay (n=12) BMGU had equivalent success rate of 86.67% and 83.33% and comparable complications.Conclusions: Surgery for urethral stricture differs according to site and extent of stricture. Single stage BMG urethroplasty is preferred modality for long segment bulbar, penile and panurethral stricture.

Efficacy of oral steroids after optical internal urethrotomy in reducing recurrence of urethral strictures.

Optical internal urethrotomy is a feasible modality of treatment for short segment bulbar urethral strictures. Recurrence is an important problem after urethrotomy. This study aimed at evaluating the efficacy of oral steroid (deflazocort) in reducing the recurrence of strictures after urethrotomy. Up to date, no study has evaluated the role of oral steroids after urethrotomy. In this case-control study, patients undergoing urethrotomy (bulbar urethral strictures <2 cm) were divided into two groups according to patients receiving (Group 1) or not receiving (Group 2) oral steroid (deflazocort 6 mg tablets) after operation. Both groups were controlled at 1, 3 and 6 months after catheter removal (usually 5-6 days after operation) with uroflowmetry, and the flow rates were statistically compared. Deflazocort was given after catheter removal, at first 6 mg twice daily for two weeks, then 6 mg once daily for another two weeks (self-obturation was not performed). A total of 72 patients were selected for the study as per inclusion criteria. They were divided into 2 groups as those receiving (Group 1: deflazocort group; n=36) or not receiving (Group 2; n=36) deflazocort. Median postoperative maximum flow rates in the deflazocort group were 26.2, 22.3 and 18.2 mL/sec, and in the control group was 24.4, 17.1 and 13.7 mL/sec at postoperative 1., 3. and 6. months, respectively. Lesser patients in the deflazocort group had recurrence. The difference was statistically significant only at postoperative 3 (p value=0.03), and 6. months (p value=0.02) (p value=0.15). Oral steroids can be used after internal urethrotomy to reduce the recurrence of urethral strictures.

Comparison of cold-knife optical internal urethrotomy and holmium:YAG laser internal urethrotomy in bulbar urethral strictures.

IntroductionTo compare the results of cold-knife optical internal urethrotomy (OIU) and Holmium:YAG laser internal urethrotomy (HIU) in primary bulbar urethral strictures.Material and methodsA total of 63 patients diagnosed with primary bulbar urethral stricture between August 2014 and September 2015 were assigned to the OIU (n = 29) and HIU (n = 34) groups. The demographic variables, biochemistry panels, and preoperative and postoperative uroflowmetry results including the maximum flow rate (Qmax) and mean flow rate (Qmean) values, retrograde urethrography, and diagnostic flexible urethroscopy findings were recorded prospectively. Demographic features and preoperative values were not statistically different between groups (p >0.05). Mean surgical times were 18.4 ±2.3 min for OIU and 21.9 ±3.8 min for HIU groups, which was statistically significant (p <0.05). There was no significant difference in complication rates in both groups (p = 0.618).ResultsPostoperative Qmax values were increased in both groups even though postoperative Qmax values were not significantly different between the two groups in the short- and long-term results at 3, 6, and 12 months (p >0.05). There was no recurrence in the first 3 months in either group. The urethral stricture recurrence rate up to month 12 was not statistically significant for the OIU group (n = 6, 20.7%) as compared to the HIU group (n = 11, 32.4%; p = 0.299).At follow-up, the SFR and IFR was 96% and 88% at 3-months, and 82% and 71% at 12-months, respectively (p <0.001). While almost three-quarters of patients were stone and infection free at 12-months, the majority of those with stones recurrence also had recurrence of their UTI.ConclusionsHIU is an alternative method to OIU, and it has similar success rates in the treatment of short segment bulbar urethral strictures.

PD34-01 ANASTOMOTIC BULBAR URETHROPLASTY: TO TRANSECT OR NOT TO TRANSECT?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2017PD34-01 ANASTOMOTIC BULBAR URETHROPLASTY: TO TRANSECT OR NOT TO TRANSECT? Dave Chapman, Adam Kinnaird, Jon Witten, and Keith Rourke Dave ChapmanDave Chapman More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , Jon WittenJon Witten More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1524AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anastomotic urethroplasty is an effective but occasionally controversial treatment for short bulbar urethral strictures. Non-transecting variations of anastomotic urethroplasty were created in part to address this controversy. The objective of this study is to assess current outcomes of anastomotic urethroplasty and compare outcomes of transecting and non-transecting techniques. METHODS 171 patients with complete follow-up underwent anastomotic bulbar urethroplasty from September 2003 to May 2016. Patient age, stricture length, location, etiology, 90-day complications and semi-quantitative assessment of sexual dysfunction were recorded. The primary (objective) outcome was success defined as urethral patency >16Fr on routine follow-up cystoscopy. Secondary outcome measures included 90-day complications (Clavien ≥2) and de novo sexual dysfunction assessed at 6 months. Statistical comparison between transecting and non-transecting cohorts was made using Cox Regression Analysis and Chi-square when appropriate. RESULTS One hundred and thirty patients underwent transecting anastomotic urethroplasty while 41 had a non-transecting anastomotic urethroplasty. Mean stricture length was 1.5±0.5cm (range 1-3) with a mean patient age of 43.0±18.0 years. 78.9% of patients failed prior endoscopic treatment (135/171) and 2.4% failed prior urethroplasty (4). Overall there was a 98.2% (168/171) success rate with a mean follow-up of 74.9(±46.7) months. 7.0% (12/171) of patients experienced a 90-day postoperative complication of Clavien ≥2 including 2.9% wound-related complications (5), 1.8% scrotal hematomas (3), 1.8% UTI (3), and 0.6% urethral bleeding (1). 9.9% reported an adverse change in sexual function including 6.4% erectile dysfunction (11), 1.8% ejaculatory dysfunction (3), 1.2% painful erection (2), and 0.6% chordee (1). When comparing transecting and non-transecting technique success using Cox Regression analysis there was no difference in urethroplasty success (97.7% vs. 100%; p=0.63) and no difference in postoperative complications (7.7% vs. 4.9%; p=0.73) but patients undergoing transecting anastomotic urethroplasty were more likely to report an adverse change in sexual function (13.1%; vs. 0%; p=0.013). CONCLUSIONS Anastomotic urethroplasty remains a highly effective treatment for short-segment bulbar urethral strictures with relatively minimal associated morbidity. Newer non-transecting anastomotic urethroplasty techniques appear to compare favorably in the short-term and may reduce the risk of associated sexual dysfunction. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e657 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Dave Chapman More articles by this author Adam Kinnaird More articles by this author Jon Witten More articles by this author Keith Rourke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intraoperative breakage of Sachse’s knife blade: a rare complication of optical internal urethrotomy (one case managing experience)

ABSTRACTOptical internal urethrotomy (OIU) is the most common procedure performed for short segment bulbar urethral stricture worldwide. This procedure most commonly performed using Sachse’s cold knife. Various perioperative complications of internal urethrotomy have been described in literature including bleeding, urinary tract infection, extravasation of fluid, incontinence, impotence, and recurrence of stricture. Here we report a unique complication of breakage of Sachse knife blade intraoperatively and its endoscopic management.

Short segment bulbar urethral strictures: Review of 48 cases managed in a resource-poor setting.

To share our experience on the presentation and management of short segment bulbar urethral strictures (BUSs) in a resource-poor center. Short segment bulbar urethral strictures (BUSs) managed from January 2009 to December 2014 were analyzed. Patients'age, stricture aetiology, mode of presentation, stricture characteristics, time to surgery, associated morbidity, operative procedure, and post-operative outcome were reviewed. All patients had bulbar anastomotic urethroplasty (BAU). Total 42 bulbar anastomotic urethroplasties (BAUs) were done. The mean age of the patients in years was 37.46 (± 13.80). Fall astride injuries accounted for most strictures, 39(89.3%) of cases. The mean stricture lenght was 1.04 cm ± 0.49 and was longer in patients who had prior instrumentation,1.45 cm (± 0.37) versus 0.70 cm (± 0.26), P = 0.000. Associated lower urinary tract comorbidities were noted in 38 (79.2%) patients. Mean time to surgery was 10.20 (± 4.96) months. Patients operated on after 6 months of presentation had more associated comorbidities, 24/26 patients (92.3%), compared to those operated on within 6 months; 8/16 cases (50%), P = 0.003. However, this did not impact negatively on the outcome of surgery (P = 0.275). Patients with complete strictures tended to accept surgery earlier than those with incomplete strictures, 29 patients (60.4%) versus 19 patients (39.6%), P = 0.208,with no difference in outcome between the two groups, P = 0.581.The overall success rate was 92.9%. Fall astride injuries are the commonest cause of short segment BUSs. Prior urethral instrumentation is associated with recurrence and longer stricture lenght. Suprapubic catheter-related associated comorbidity increases with the duration of catheterization but does not impact negatively on the surgical outcome. BAU has low morbidity and high success rate of 92.7%. It should be the first line treatment for short segment BUS in low-resource countries.

Holmium laser vs. conventional (cold knife) direct visual internal urethrotomy for short-segment bulbar urethral stricture: Outcome analysis.

Our goal was to analyze the outcome between holmium laser and cold knife direct visual internal urethrotomy (DVIU) for short-segment bulbar urethral stricture. We conducted a prospective study comprised of 112 male patients seen from June 2013 to December 2014. Inclusion criterion was short-segment bulbar urethral stricture (≤1.5cm). Exclusion criteria were prior intervention/urethroplasty, pan-anterior urethral strictures, posterior stenosis, urinary tract infection, and those who lost to followup. Patients were divided into two groups; Group A (n=58) included cold knife DVIU and group B (n=54) included holmium laser endourethrotomy patients. Patient followup included uroflowmetry at postoperative Day 3, as well as at three months and six months. Baseline demographics were comparable in both groups. A total of 107 patients met the inclusion criteria and five patients were excluded due to inadequate followup. Mean stricture length was 1.31 ± 0.252 cm (p=0.53) and 1.34 ± 0.251 cm in Groups A and B, respectively. Mean operating time in Group A was 16.3 ± 1.78 min and in Group B was 20.96 ± 2.23 min (p=0.0001). Five patients in Group A had bleeding after the procedure that was managed conservatively by applying perineal compression. Three patients in Group B had fluid extravasation postoperatively. Qmax (ml/s) was found to be statistically insignificant between the two groups at all followups. Both holmium laser and cold knife urethrotomy are safe and equally effective in treating short-segment bulbar urethral strictures in terms of outcome and complication rate. However, holmium laser requires more expertise and is a costly alternative.

COMPARISON OF SEXUAL DYSFUNCTION BETWEEN END-TO-END ANASTOMOSIS AND BUCCAL MUCOSA GRAFT

Objective: The aim of this study was to compare long term follow-up of sexual dysfunction between end-to-end anastomosis or buccal mucosa graft in short segment bulbar urethral stricture. Material &amp; Method: We performed a meta analysis of cohort study. The data sources was MEDLINE from 1980 through 2011. A fixed effects model with Mantel-Haenszel method was used to calculate the pooled Risk Ratio (RRs) and 95% Confidence Interval (CIs). We assessed the heterogeneity by calculating the I2 statistic. All analyses were performed with Stata statistical software, version 10.0 (Stata Corp). Results: We analyzed 6 cohort studies. End-to-end anastomosis and buccal mucosa graft patients who complained about sexual dysfunction were 24.6% (45/183) and 9.1% (11/122) respectively, with overall RR 2.54 (95% CI, 0.22-0.69, p = 0.001). Conclusion: Buccal mucosa graft showed a superior outcome compared to end-to-end anastomosis, based on sexual dysfunction in ≤ 3 cm bulbar urethral stricture treatments.Keywords: Sexual dysfunction, end-to-end anastomosis, buccal mucosa graft, anterior urethral stricture.

Management von Harnröhrenstrikturen

Urethral strictures represent a relevant problem, particularly among urological patients, since they can also develop in conjunction with endourological instrumentation. After functional and radiological diagnostics, the choice of an individualized treatment concept is foremost while taking into consideration minimally invasive endourological procedures and techniques of surgical reconstruction. The best long-term results for this disorder, which has a considerable tendency to recur, are achieved with open reconstructive methods whereas urethrotomy pursues a curative approach only in cases of short-segment bulbar urethral strictures without spongiofibrosis.

CAN OUTCOME OF INTERNAL URETHROTOMY FOR SHORT SEGMENT BULBAR URETHRAL STRICTURE BE PREDICTED?

We predicted the outcome of visual internal urethrotomy (VIU) by measuring the percentage of lumen narrowing at the stricture site on retrograde urethrography (RGU). From January 1991 to June 2002 patients with primary bulbar urethral strictures who underwent VIU were selected for the study. Patients with a history of intervention, complete block of the urethral lumen and stricture greater than 2 cm were excluded from study. Urethral diameter at the area of maximum stenosis and at the normal distal urethra was measured on RGU with Vernier caliper and percentage narrowing was derived. Patients were followed 3 times monthly with symptoms, calibration and whenever required with RGU. Recurrence of symptoms, failure to self-calibrate and the need for secondary procedure were considered treatment failure. Complete followup data were available in 105 patients (44 grade 1 and 61 grade 2). Mean bulbar urethral stricture length was 0.86 cm. Inflammation was the cause of stricture in 83 (79%) and trauma the cause in 22 (21%) patients. In the Cox proportional hazards model only grade of narrowing had a significant impact on outcome. There were 41 cases of treatment failure in the total followup of 46 +/- 9 months. Mean recurrence-free duration +/- SD was 13 +/- 15 and 44.52 +/- 19 months in cases of treatment failure and success, respectively (p <0.0001). Mean percentage narrowing was significantly higher with treatment failure (69.9% +/- 16.1% vs 48.55% +/- 17.3%, p <0.0001). A cutoff of 74% for urethral narrowing was derived to predict the outcome with 78% probability. Percentage narrowing of the urethral lumen at the stricture site is a useful predictor of VIU outcome.