Recurrent Stenosis Research Articles

Lateral incision 1-stage urethroplasty with oral mucosal graft for patients with penile urethral stricture after hypospadias repair—a preliminary report

PurposeTo report our early experience of a novel surgical approach for penile urethral strictures after hypospadias repair, using a lateral incision to keep the ventral tissue and vasculature of the penis intact and to avoid the need for tissue interposition.Patients and methodsA total of 21 patients underwent lateral incision 1-stage urethroplasty with oral mucosal graft. The median age of the patients was 21 years old (range, 13–47). The median number of prior procedures for hypospadias repair was 3 (range, 1–9) with 18 of 21 patients (85.7%) undergoing greater than 1 prior reconstructive procedure. The mean length of the penile urethral strictures was 4.5 ± 1.7 cm, with a range of 1.0 to 8.0 cm. Selection criteria for lateral incision 1-stage urethroplasty include: non-obliterative stricture, no or mild penile curvature and no urethrocutaneous fistula.ResultsMedian follow-up was 30 months (range, 6–73). Success was achieved in 17 of 21 patients (80.9%). The 4 (19.0%) patients with treatment failure developed recurrent urethral strictures. Of the 4 men with recurrent strictures, 3 were ultimately treated successfully by DVIU (2) or two-stage urethroplasty (1), and one patient chose repeated dilation.ConclusionsFor patients with penile urethral stricture after hypospadias repair with non-obliterative stricture, no significant penile curvature and no urethrocutaneous fistula, a lateral approach with oral mucosal graft is a simple technique that avoids the need for tissue interposition and keeps the penile ventral tissue and vasculature intact, resulting in a low risk of complications.

Use of a novel biliary stent to prevent distal stent migration in benign anastomotic stricture.

Endoscopic treatment using balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP) is useful for hepaticojejunostomy anastomotic strictures. Although biliary stent placement is conducted to avoid stricture recurrence or realize stricture resolution after balloon dilation [1] [2], distal stent migration is a common problem [3] [4].

Male Urethral Stricture in Patients with Metabolic Syndrome.

Urethral stricture is characterized by fibrosis that decreases urine flow. Metabolic syndrome is a complex disorder that causes fibrosis in many organs. This study aimed to evaluate the relationship between metabolic syndrome and appearance of urethral stricture and effects of metabolic syndrome on the recurrence of urethral stricture in patients with primary urethral stricture who underwent direct visual internal urethrotomy. One hundred thirty-two male patients who underwent direct visual internal urethrotomy between 2014 and 2021 because of primary urethral stricture were included. Location, length, and type of urethral stricture, time from diagnosis to surgery, postoperative follow-up, time from surgery to recurrence, and postoperative follow-up duration with a urethral catheter were retrospectively analyzed and association with metabolic syndrome was evaluated. The mean age was 50.48 ± 17.94 years. Recurrence was found in 34.1% and metabolic syndrome in 27.3%. Postoperative follow-up duration was significantly longer in patients with recurrence than in those without (P=.033). There was no statistically significant difference in terms of metabolic syndrome and postoperative urethral catheterization between patients with and without recurrence (P=.126, P=.714, respectively). Postoperative clean intermittent self-catheterization use was found to be statistically higher in patients with recurrence than in patients without recurrence (P=.018). Postoperative urinary tract infection rate was found to be significantly higher in patients with metabolic syndrome compared to patients without metabolic syndrome (P=.001). Metabolic syndrome was not associated with recurrence. However, postoperative urinary tract infections were more common in patients with metabolic syndrome than in patients without. Clean intermittent self-catheterization used postoperatively may increase the risk of stricture.

COMPARISON OF RECURRENCE OF URETHRAL STRICTURE AFTER INTERNAL OPTICAL URETHROTOMY WITH AND WITHOUT POST-OPERATIVE ORAL STEROIDS IN DISTRICT DERA ISMAIL KHAN

Urethral stricture is one of the most common diseases in urology. The urethral structure is the narrowing of the urethral lumen due to spongiofibrosis. It is notorious for its recurrence and accounts for the major burden on the Urology department. Internal optical urethrotomy is considered the first line of treatment for urethral stricture. When combined with clean intermittent self-catheterization, and Intralesional injections, better results could be obtained. This study compares the recurrence of urethral stricture after internal optical urethrotomy with and without post-operative oral steroids in the population of Dera Ismail Khan. The study was a non-randomized control trial done in the Urology Department, DHQ/MTI-TH, Dera Ismail Khan, Pakistan, from January 2021 to June 2021. The patients from the urology outdoor and emergency of DHQ Teaching Hospital were included in the study. A total of 152 patients were divided by lottery method into two groups’ an experimental group and Control group, each containing 76 patients. After losing follow-up, the remaining patients who completed the study were 128. The patients in both groups underwent internal optical urethrotomy with a cold knife. The experimental group of patients received oral steroids for 4 weeks. The control group didn’t receive steroids after the procedure. The mean age in the experimental group was 41 ± 09 years, while in the control group, it was 36 ± 13 years. After 6 months, the recurrence was observed in 12 patients (18.75%) in the experimental group and 25 in the control group (39.06%). These results showed a statistically significant difference in recurrence rate between these two groups with a p-value of 0.0123. Based on the results, it can be concluded that the use of oral steroids after internal optical urethrotomy decreases the risk of recurrence of urethral stricture significantly.

Economic evaluation of Optilume, a drug-coated balloon for recurrent anterior male urethral stricture.

We aim to conduct an economic evaluation of the Optilume urethral drug-coated balloon (DCB) compared with endoscopic management for the treatment of recurrent anterior male urethral stricture in England. A cohort Markov model was developed to estimate the costs and savings to the NHS over a 5-year time horizon of adopting Optilume for the treatment of anterior urethral male stricture versus current endoscopic standard of care. A scenario analysis was conducted which compared Optilume to urethroplasty. Probabilistic and deterministic sensitivity analyses were performed to estimate the impact of uncertainties in model parameters. When compared with current endoscopic standard of care Optilume resulted in an estimated cost saving of £2502 per patient if introduced in the NHS for the treatment of recurrent anterior male urethral stricture. In the scenario analysis, the use of Optilume compared with urethroplasty resulted in an estimated cost saving of £243. Results were robust to changes in individual input parameters as demonstrated in the deterministic sensitivity analyses, with the monthly probability of symptom recurrence associated with endoscopic management the only exception. Probabilistic sensitivity analysis results demonstrated that Optilume was cost saving in 93.4% of model iterations, when running 1000 iterations. Our analysis suggests that the Optilume urethral DCB treatment can be a cost-saving alternative management option for the treatment of recurrent anterior male urethral stricture within the NHS in England.

Recurrent Esophageal Stricture as a Result of Esophageal Diverticulum: Case Report

Esophageal stricture is a disorder that limiting patients’ capability to get adequate intake. Dysphagia and regurgitation are main problem that makes patient admit to the hospital. There are several causes that narrowing esophageal lumen; those could be intraluminal or extraluminal. Esophageal diverticulum is one of a kind. It is not easy to establish the diagnosis of diverticulum in esophagus segment since supporting examination needed were complex. Esophageal stricture treatment should be interdisciplinary approach because inappropriate management would increase risk of complication and lowering patient’s quality of life. The management of esophageal diverticulum could be challenging and its prognosis depends on the patient’s characteristic and comorbidity.

A comparative study of two single-stage oral mucosal substitution urethroplasty (Kulkarni and Asopa) in the surgical treatments of lichen sclerosus urethral strictures.

Long-segment lichen sclerosus (LS) urethral stricture is a challenge for urologists. Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty. In this retrospective study, we investigated the outcomes of these two procedures in patients with LS urethral stricture. Between January 2015 and December 2020, 77 patients with LS urethral stricture underwent Kulkarni and Asopa procedures for urethroplasty in the Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai, China). Of the 77 patients, 42 (54.5%) underwent the Asopa procedure and 35 (45.5%) underwent the Kulkarni procedure. The overall complication rate was 34.2% in the Kulkarni group and 19.0% in the Asopa group, and no difference was observed ( P = 0.105). Among the complications, no statistical difference was observed in the incidence of urethral stricture recurrence ( P = 0.724) or glans dehiscence ( P = 0.246) except for postoperative meatus stenosis ( P = 0.020). However, the recurrence-free survival rate between the two procedures was significantly different ( P = 0.016). Cox survival analysis showed that antiplatelet/anticoagulant therapy use ( P = 0.020), diabetes ( P = 0.003), current/former smoking ( P = 0.019), coronary heart disease ( P < 0.001), and stricture length ( P = 0.028) may lead to a higher hazard ratio of complications. Even so, these two techniques can still provide acceptable results with their own advantages in the surgical treatment of LS urethral strictures. The surgical alternative should be considered comprehensively according to the patient characteristics and surgeon preferences. Moreover, our results showed that antiplatelet/anticoagulant therapy use, diabetes, coronary heart disease, current/former smoking, and stricture length may be contributing factors of complications. Therefore, patients with LS are advised to undergo early interventions for better therapeutic effects.

Validity and Reliability of the European Organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 in Indian Patients With Corrosive-Induced Benign Refractory Esophageal Strictures.

Background The European organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 (EORTC QLQ-OG 25) is designed for patients with esophagogastric cancer. Its performance has never been tested with benign disorders. A health-related quality-of-life questionnaire does not exist for patients with benign corrosive-induced esophageal strictures. Hence, we evaluated the EORTC QLQ-OG 25 in Indian patients with corrosive strictures. Methods The English or Hindi version of QLQ-OG 25 was administered to 31 adult patients undergoing outpatient esophageal dilation at GB Pant hospital, New Delhi. These patients had refractory or recurrent esophageal strictures due to corrosive ingestion and had not undergone reconstructive surgery. Score distribution was analyzed, and item performance was determined based on floor and ceiling effects. Convergent validity, discriminant validity, and internal consistency were checked. Results The average time to finish the questionnaire was 6.70 minutes. Most scales fulfilled convergent validity (corrected item-total correlation >0.4), barring the Odynophagia scale and one item of the Dysphagia scale. Most scales exhibited divergent validity except for odynophagia and one item of dysphagia. Cronbach's alpha was >0.70 for all scales except odynophagia. Responses to questions evaluating taste, cough, swallowing saliva, and talking were highly skewed and had prominent floor effects. Overall, the questionnaire demonstrated good internal consistency, convergent validity, and divergent validity in benign corrosive-induced refractory esophageal strictures patients. Conclusion The EORTC QLQ-OG 25 can be satisfactorily used in patients with benign esophageal strictures to assess health-related quality of life.

Urethral Stricture and Methods for its Correction

A stricture is a type of narrowing of the urethra, which can be caused by a variety of reasons. In addition, urethral strictures are associated with a wide range of symptoms and require special diagnostic examination before proceeding with any treatment. The treatment of urethral strictures has remained a challenge for many years. Stricture recurrence is still a serious problem in reconstructive urology. During the second half of the 20th century, urologists tried to find solutions for treating both simple and complex urethral strictures. Within the last few decades research has mainly focused on improving existing procedures to mitigate the negative postoperative effects. Despite considerable scientific achievements in this area, numerous studies have revealed a lack of knowledge about urethral stricture surgery among urologists and have shown that patients with urethral strictures are generally offered inadequate treatment options. Currently, many surgical interventions are available to treat this condition. However, the variety of treatment methods reflects a lack of optimal technique. This bibliographical review presents data on the effectiveness of minimally invasive (endoscopic) and various urethroplasty options in urological practice.

Effectiveness of clean intermittent self catheterization in patients with recurrent urethral stricture post visual internal urethrotomy

Effectiveness of clean intermittent self catheterization in patients with recurrent urethral stricture post visual internal urethrotomy

Redo Robotic Ureteroplasty After Prior Failed Ureterocalicostomy

Clinical History: Surgical management of patients with recurrent strictures after prior ureterocalicostomy for complex ureteropelvic junction obstruction is challenging because of extensive periureteral fibrosis and scarring that is present in this setting. Physical Examination: The patient presented with left flank pain. Diagnosis: We report the case of a 37-year-old male patient with a recurrent symptomatic stricture after undergoing a laparoscopic converted to open left ureterocalicostomy 12 years prior. Retrograde pyelogram showed a small filling defect and 1 cm narrowed segment at the ureter's insertion point into the lower pole calix. Intervention: We describe our approach for robotic ureteral reconstruction for patients with recurrent strictures after prior ureterocalicostomy. We highlight the utilization of intravenous indocyanine green (ICG) to facilitate identification of the strictured aspect of the ureter. A longitudinal incision was made along the strictured segment and a buccal mucosa graft was anastomosed to the defect in onlay manner. Follow-Up/Outcomes: Intraoperatively, operative time was 213 minutes and estimated blood loss was 100 mL. There were no intraoperative complications and the patient was discharged on the same day. At follow-up of 20 months, the patient had no flank pain and his postoperative renal scan showed normal split function and half washout time of 12 minutes bilaterally. Robotic ureteral reconstruction may be utilized for management of patients with recurrent ureteral strictures after prior ureterocalicostomy. Near infrared fluorescence with ICG may assist with identification of the strictured ureter in these complex settings. This surgical approach may reduce damage to the fragile periureteral blood supply and minimize the risk of stricture recurrence. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The study was approved by the institutional review board at Temple University (protocol number 20793). M.L. and J.J. have no conflicts of interest to disclose. D.E. is founder of Melzi corp and a consultant for Intuitive Surgical and Johnson and Johnson. Runtime of video: 4 mins 45 secs

MP78-10 IMPROVING PREDICTIVE UTILITY OF URETHRAL STRICTURE CLASSIFICATION SYSTEMS BASED ON SURVIVAL ANALYSIS OF STRICTURE-SPECIFIC VARIABLES

You have accessJournal of UrologyCME1 Apr 2023MP78-10 IMPROVING PREDICTIVE UTILITY OF URETHRAL STRICTURE CLASSIFICATION SYSTEMS BASED ON SURVIVAL ANALYSIS OF STRICTURE-SPECIFIC VARIABLES Keith Rourke, Subash Subramanian, and Nathan Hoy Keith RourkeKeith Rourke More articles by this author , Subash SubramanianSubash Subramanian More articles by this author , and Nathan HoyNathan Hoy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethroplasty is generally regarded as the most effective treatment of urethral stricture. However, recurrences and complications can occur even in the most skilled hands and reliably predicting these outcomes remains elusive. Several existing classification systems (U-Score and LSE) exist but remain largely unvalidated. The purpose of this study is to examine stricture-specific factors associated with recurrence after anterior urethroplasty in order to better refine existing classification systems. METHODS: A retrospective review was performed of men undergoing anterior urethroplasty at a single center from 2003-2021. Stricture-specific variables of location, etiology, length, number, prior urethroplasty and previous endoscopic treatment were identified. Additionally, U Scores (US) and LSE Scores were calculated. Success was defined as easy passage of a flexible cystoscope at routine follow-up with no change in urinary function thereafter. Complications were defined as a Clavien >1 complication during the 90-day perioperative time period. Associations between clinical variables and stricture recurrence were evaluated using univariable and multivariable Cox regression analysis. Variables independently associated with stricture recurrence were sub-stratified using Kaplan-Meier analysis and arranged into a survival-analysis based classification system. Receiver operator characteristic (ROC) analysis was performed on U-Score (US), LSE and refined classification system. RESULTS: 1573 patients underwent anterior urethroplasty over the study period with a median patient age of 47 years (IQR 34-59) and stricture length of 4 cm (IQR 3-6). Urethroplasty success was 92.0% (1447) at a median follow-up of 90 months. On multivariable Cox regression, stricture length (Hazard Ratio 1.09, 95%CI 1.04-1.16, p=0.001), etiology (HR 1.16, 95%CI 1.06-1.28, p=0.002), revision urethroplasty (HR 1.56, 95%CI 1.07-2.28, p=0.02), stricture number (HR 2.34, 95%CI 1.01-7.43, p=0.05), and location (HR 1.32, 95%CI 1.04-1.68, p=0.02) were independently associated with stricture recurrence after anterior urethroplasty. On Kaplan-Meier analysis there was clustering within each independent variable which allowed revision to a stricture-specific classification termed “LERNS” (Length, Etiology, Revision, Number and Segment). On ROC analysis, area under the curve (AUC) for LERNS indicated excellent discrimination as a predictive tool for stricture recurrence (AUC 0.76, 95%CI 0.71-0.80, p<0.001). This was superior to both US (AUC 0.71, 95%CI 0.66-0.75, p<0.001) and LSE (AUC 0.69, 95%CI 0.64-0.74, p<0.001) confirmed with bootstrap analysis using 1000 replicates. On ROC analysis, both US (AUC 0.57, 95%CI 0.51-0.62, p=0.01) and LERNS (AUC 0.58, 95%CI 0.53-0.63, p=0.001) significantly predicting 90-day complications but with overall poor diagnostic discrimination. CONCLUSIONS: While increasing U-Score and LSE scale are both associated with stricture recurrence, modifying these systems as “LERNS” (Length, Etiology, Revision, Number, Segment) provides excellent discrimination when predicting stricture recurrence. However, accurately predicting 90-day complications will likely require further incorporation of patient-specific parameters. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1135 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Keith Rourke More articles by this author Subash Subramanian More articles by this author Nathan Hoy More articles by this author Expand All Advertisement PDF downloadLoading ...

PD35-12 MULTI-INSTITUTIONAL ANALYSIS OF SURGERY FOR LICHEN SCLEROSUS INDUCED PENILE URETHRAL STRICTURES: CONFIRMING SINGLE-STAGE URETHROPLASTY AS THE TREATMENT STANDARD

You have accessJournal of UrologyCME1 Apr 2023PD35-12 MULTI-INSTITUTIONAL ANALYSIS OF SURGERY FOR LICHEN SCLEROSUS INDUCED PENILE URETHRAL STRICTURES: CONFIRMING SINGLE-STAGE URETHROPLASTY AS THE TREATMENT STANDARD Ross Hengel, Alex Vanni, Bradley A Erickson, Sean Elliott, Benjamin Breyer, Jill C Buckley, Joshua Broghammer, Bryan Voelzke, Jeremy B Myers, Nathan Hoy, and Keith Rourke Ross HengelRoss Hengel More articles by this author , Alex VanniAlex Vanni More articles by this author , Bradley A EricksonBradley A Erickson More articles by this author , Sean ElliottSean Elliott More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Jill C BuckleyJill C Buckley More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Jeremy B MyersJeremy B Myers More articles by this author , Nathan HoyNathan Hoy More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal treatment of penile urethral strictures related to lichen sclerosus (LS) is controversial. At the heart of the debate lies the issue of whether or not a single-stage reconstruction should be employed over a 2-stage repair to minimize the number of surgeries performed. Additionally, depending on patient preference, a urethrostomy is a viable option. The objective of this study is to compare single-stage urethroplasty, staged urethroplasty and perineal urethrostomy for the treatment of LS related penile urethral strictures in a multi-institutional analysis. METHODS: A retrospective analysis was performed on patients undergoing urethroplasty for LS induced isolated penile urethral strictures (LSE S2b/S2c) at 9 different institutions. Meatal strictures <2 cm in length and panurethral strictures (>10 cm) involving the bulbar urethra were excluded from study. Patients were reconstructed using either a single-stage approach, a staged technique or perineal urethrostomy. The primary outcome measure was urethral patency at routine follow-up cystoscopy without stricture intervention thereafter and secondary outcomes were 90-day complications, and adverse change in sexual dysfunction, chordee or urethrocutaneous fistula. Outcomes were compared using a Cox regression or a two-tailed Chi-square test when appropriate. RESULTS: 231 patients were analyzed with an average age of 51.6 years and mean stricture length of 5.5 cm. Prior endoscopic treatments were performed in 197 patients (85.3%) with a mean of 3.0 prior endoscopic treatment attempts. Overall, 127 (55.0%) were managed with single-stage BMG urethroplasty, 44 (19.0%) with staged BMG, and 60 (26.0%) with perineal urethrostomy. At a mean follow-up of 68.6 months, overall stricture free rate was 81.0% (n=187). Clavien ≥2 90-day complications occurred in 17 patients (9.8%). de novo erectile dysfunction occurred in 13 patients (5.6%), chordee in 7 (4.8%), and urethrocutaneous fistula in 3 (3.4%). On Mantel-Cox testing, there was no difference in stricture recurrence between techniques (15.7% vs. 27.3% vs. 20.0%; p=0.60) and no difference in 90-day complications (8.0% vs. 15.6% vs. 9.8%; p=0.45), erectile dysfunction (7.1% vs. 4.5% vs. 3.3%; p=0.55), chordee (6.7% vs. 0.0% vs. 3.6%; p=0.33), and urethrocutaneous fistula (2.2% vs. 9.1% vs. 0.0%; p=0. 0.17). On Cox regression analysis, obesity (BMI>35) was associated with a higher rate of stricture recurrence (Hazard Ratio 2.31, 95%CI 1.28-4.17, p=0.006, 30.1% vs. 13.9%) but not 90-day complications (Odds Ratio 1.00, 95% CI 0.33-2.99, p=0.99, 9.8% vs. 9.8%). No other clinical variable was associated with stricture recurrence or 90-day complications. CONCLUSIONS: Favorable outcomes of single-stage techniques for the treatment of lichen sclerosus induced penile urethral strictures, confirm single-stage urethroplasty as the treatment standard for LS induced penile urethral strictures especially when considering the decreased number of surgeries the patient is exposed to. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e979 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ross Hengel More articles by this author Alex Vanni More articles by this author Bradley A Erickson More articles by this author Sean Elliott More articles by this author Benjamin Breyer More articles by this author Jill C Buckley More articles by this author Joshua Broghammer More articles by this author Bryan Voelzke More articles by this author Jeremy B Myers More articles by this author Nathan Hoy More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...

Does mitomycin-C and triamcinolone injection therapy during optical urethrotomy able to reduce the recurrence of urethral stricture? A comparison study.

Background: Male urethral stricture is one of the common diseases. Stricture disease may lead to severe complications which badly affect the quality of life like urinary tract infection, vesical stones, urethrocutaneous fistulas, sepsis, and finally renal impairment. Due to its high recurrence rates, it is one of the most complex and challenging issues in urological practice. The aim of the study is to evaluate the effect of intralesional mitomycin-C and triamcinolone after direct visualized internal urethrotomy on the recurrence of urethral stricture. Method and patient: An observational comparative study that was conducted between September 2019 and October 2021. It included 34 male participants with urethral stricture. Twelve participants were in group A in whom participants underwent direct visualized internal urethrotomy with no adjuvant treatment, 11 participants were in group B who underwent direct visualized internal urethrotomy with mitomycin-C injection and another 11 patients underwent direct visualized internal urethrotomy with triamcinolone injection were in group C. Patients were selected from outpatient clinic. Patients with idiopathic causes of stricture, traumatic non-instrumental or post-urethroplasty stricture, recurrent stricture and stricture more than 15 mm in length were excluded from the study. Follow up was done at 3, 6 and 12 months post-operatively. Result: In this study, only one patient among 11 who received mitomycin-C injection (9.1%) had recurrence while 2 out of 11 patients who received triamcinolone (18.2%) had recurrence. Six out of 12 patients (50%) who undergone direct visualized internal urethrotomy only had recurrence. Adjuvant therapy decreased the recurrence rates, and the results were statistically significant. No correlation between stricture recurrence time and the type of adjuvant therapy used was found. Relationship between recurrence rate of stricture and various other variables such as age of the patient, length of stricture, stricture site and etiology were not observed in the study as the p-value was greater than 0.05. Conclusions: Intralesional injection of either Mitomycin-C or Triamcinolone reduces the recurrence rate of urethral strictures with statistically significant results.

PD35-08 4 YEARS OF THE OPTILUME® DRUG COATED BALLOON FOR RECURRENT ANTERIOR URETHRAL STRICTURES: A SUMMARY OF ROBUST I, II AND III

You have accessJournal of UrologyCME1 Apr 2023PD35-08 4 YEARS OF THE OPTILUME® DRUG COATED BALLOON FOR RECURRENT ANTERIOR URETHRAL STRICTURES: A SUMMARY OF ROBUST I, II AND III Rachel Mann, Jessica Delong, Ramon Virasoro, and Sean Elliott Rachel MannRachel Mann More articles by this author , Jessica DelongJessica Delong More articles by this author , Ramon VirasoroRamon Virasoro More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Optilume Drug Coated Balloon has been studied in three clinical investigations (ROBUST I, II and III). ROBUST I was the first in man trial conducted as a single arm, prospective multicenter study in Latin America (4 sites, 53 subjects) followed by ROBUST II assessing early feasibility (5 sites, 15 subjects), and ROBUST III, the randomized pivotal trial (79 Optilume). Optilume data combined from all three studies are presented here. METHODS: A total of 148 subjects were treated with Optilume in ROBUST I, II and III in Latin America, Canada, and the United States. Men with strictures ≤ 3cm and 1-4 prior endoscopic interventions were treated with Optilume. Follow-up was completed at 3 months, 6 months and annually thereafter. All studies were designed to follow subjects through 5 years with Robust I at 4-year follow-up, Robust II at 3-year follow-up and Robust III at 2-year follow-up, currently. Outcomes included International Prostate Symptom Score (IPSS), quality of life, freedom from reintervention, erectile function, flow rate, and post-void residual volume. Subjects receiving secondary treatment were considered failures. The safety endpoint assessed serious urinary events. RESULTS: At the time of this abstract submission, IPSS improved in all patients treated with Optilume from 22.5 at baseline to 7.8 at 4 years. Peak urinary flow rate (Qmax) had a sharp improvement and was sustained through follow-up in all trials (7.1 to 14). Freedom from repeat intervention is approximately 73% at 4 year follow-up (Figure 1). Results will be updated at the time of the presentation. CONCLUSIONS: Subjects with recurrent bulbar strictures treated with Optilume® paclitaxel-coated balloon exhibited significant improvement in symptomatic and functional outcomes through 4 years post treatment with demonstrably improved recurrence rates. There was no impact on erectile function and there were no serious adverse events. Source of Funding: Urotronic © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e977 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Mann More articles by this author Jessica Delong More articles by this author Ramon Virasoro More articles by this author Sean Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-02 MEDIUM TO LONG-TERM OUTCOMES OF VENTRAL-ONLAY BUCCAL MUCOSA GRAFT SUBSTITUTION URETHROPLASTY FOR FEMALE URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP74-02 MEDIUM TO LONG-TERM OUTCOMES OF VENTRAL-ONLAY BUCCAL MUCOSA GRAFT SUBSTITUTION URETHROPLASTY FOR FEMALE URETHRAL STRICTURE Elizabeth Day, Helena Gresty, Anthony Noah, Richard Nobrega, Jeremy Ockrim, and Tamsin Greenwell Elizabeth DayElizabeth Day More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female urethral stricture (FUS) is rare. Urethroplasty is becoming increasingly popular however there is little to guide choice of technique as all series to date contain small numbers with limited follow-up. We report the medium to long-term outcomes of ventral-onlay buccal mucosa graft substitution urethroplasty (VOBMGSU) in treating FUS. METHODS: A retrospective review of a prospectively acquired database of 52 consecutive women (median age 51 years, range 31-71) with urethral stricture having VOBMGSU since June 2012 and a median follow up 38.2 months, range 8.1-111.9). Data was analysed for stricture recurrence, change in peak free flow rate (Qmax), post-void residuals (PVR) and Patient Global Impression of Improvement (PGII) using a 7-point Likert scale where 1=very much better and 7=very much worse). Short and longer-term complications of surgery were noted. Persistent or de-novo lower urinary tract symptoms (LUTS) were investigated to delineate their cause – and this is detailed. Statistical analysis was performed with the Wilcoxon signed rank test, Students T Test and Mann-Whitney U Test. RESULTS: At last follow-up 46/52 (88.5%) of women were stricture free. Mean Qmax significantly improved from 6 ml/s (range 0-24) to 14 ml/s (range 5-31) (p<0.05). Mean PVR significantly reduced from 112 mls (range 0-609) to 38 mls (range 9-86) (p<0.05). Short and longer-term complication rates were low. 1/48 (2.1%) patients developed mild de novo SUI, which settled with conservative measures by 6 months post urethroplasty. Frequency persisted in 6/52 (9.7%) and was managed with intravesical Botox in 2 and Sacral Neuromodulation in 1. Stricture recurrence was managed by meatotomy in 1, meatal dilatation in 2, redo-VOBMG urethroplasty in 2 and vaginal flap meatoplasty in 1 with resolution of stricture in 5. Median PGII at 12 months post VOBMG urethroplasty was 1 (1-4) and this was maintained at 36 months post-surgery. CONCLUSIONS: Medium term results in the largest series of VOBMG female urethroplasty to date are excellent with stricture free rates of 88.5%, median PGII of 1 and significantly improved Qmax and PVRs. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1069 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Day More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

MP78-08 OUTCOMES OF URETHROPLASTY FOR SYNCHRONOUS ANTERIOR URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP78-08 OUTCOMES OF URETHROPLASTY FOR SYNCHRONOUS ANTERIOR URETHRAL STRICTURE Marcus Jamil, Alexandra Hansma, Nejd Alsikafi, Benjamin Breyer, Joshua Broghammer, Jill Buckley, Sean Elliott, Bradley Erickson, Jeremy Meyers, Andrew Peterson, Keith Rourke, Thomas Smith, Bryan Voelzke, Lee Zhao, and Alex Vanni Marcus JamilMarcus Jamil More articles by this author , Alexandra HansmaAlexandra Hansma More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Jill BuckleyJill Buckley More articles by this author , Sean ElliottSean Elliott More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Jeremy MeyersJeremy Meyers More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Keith RourkeKeith Rourke More articles by this author , Thomas SmithThomas Smith More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Lee ZhaoLee Zhao More articles by this author , and Alex VanniAlex Vanni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of male anterior urethral stricture disease (USD) has been well described. Less is known regarding the management strategies and outcomes in patients with synchronous USD (SUSD). SUSD is the presence of two distinct urethral strictures separated by a healthy intervening urethral segment. This study sought to assess the functional outcomes following repair of SUSD. METHODS: Patients with documented SUSD within a multi-institutional database were retrospectively assessed and compared to patients with solitary USD. Patients who underwent single-stage or staged anterior urethroplasty, including meatoplasty and perineal urethrostomy were included. Patients with a posterior urethral stricture or bladder neck involvement were excluded. Stricture classification according to the LSE (Length, Urethral Segment, Etiology) was performed. Stricture recurrence between cohorts was assessed, defined as undergoing repeat treatment. Logistic regression was performed to assess predictors of failure. RESULTS: 168 of the 2,299 patients had SUSD (7.3%). Patients with SUSD had a significantly shorter mean primary stricture length than those with solitary USD, 3.6 cm vs. 4.7 cm, p<0.001. Mean stricture length for the secondary stricture was 2.6 cm. Patients with SUSD had a larger proportion of strictures classified as S2b, S2c and S2d than in those with solitary USD (p<0.001). Patients with SUSD were more likely to be due to Lichen Sclerosus (LS) or hypospadias (Table 1). On univariate analysis, SUSD had a higher stricture retreatment rate, 8.0% vs. 13.1%, p=0.02. On multivariable analysis, SUSD was not associated with higher retreatment rates, OR 1.37 (0.79–2.28), p=0.2. Patients with SUSD and stage S1a, S1b, S2c, S2d and S3 stricture location demonstrated higher rates of stricture recurrence than controls (Table 2). CONCLUSIONS: Patients with SUSD have higher rates of stricture recurrence following urethroplasty compared to patients with solitary USD on univariate analysis. Patients with LS and hypospadias are more likely to have SUSD. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1134 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcus Jamil More articles by this author Alexandra Hansma More articles by this author Nejd Alsikafi More articles by this author Benjamin Breyer More articles by this author Joshua Broghammer More articles by this author Jill Buckley More articles by this author Sean Elliott More articles by this author Bradley Erickson More articles by this author Jeremy Meyers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Bryan Voelzke More articles by this author Lee Zhao More articles by this author Alex Vanni More articles by this author Expand All Advertisement PDF downloadLoading ...

MP78-09 SALVAGE DIRECT VISION INTERNAL URETHROTOMY FOR AFTER FAILED SUBSTITUTION URETHROPLASTY: EXTENDED LONG-TERM FOLLOW-UP FROM A RECONSTRUCTIVE REFERRAL CENTER

You have accessJournal of UrologyCME1 Apr 2023MP78-09 SALVAGE DIRECT VISION INTERNAL URETHROTOMY FOR AFTER FAILED SUBSTITUTION URETHROPLASTY: EXTENDED LONG-TERM FOLLOW-UP FROM A RECONSTRUCTIVE REFERRAL CENTER Dejan K. Filipas, Roland Dahlem, Phillip Marks, Tim A. Ludwig, Silke Riechardt, Margit Fisch, and Malte W. Vetterlein Dejan K. FilipasDejan K. Filipas More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Phillip MarksPhillip Marks More articles by this author , Tim A. LudwigTim A. Ludwig More articles by this author , Silke RiechardtSilke Riechardt More articles by this author , Margit FischMargit Fisch More articles by this author , and Malte W. VetterleinMalte W. Vetterlein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is controversy regarding the optimal salvage treatment option for stricture recurrence after anterior buccal mucosal graft urethroplasty (BMGU). Data on retreatment modalities and their outcomes are scarce. Thus, we aimed to report on our extended follow-up of patients undergoing direct vision internal urethrotomy (DVIU) for short, veil-like recurrences after anterior BMGU. METHODS: We included all men undergoing salvage DVIU for recurrence with short segment, anastomotic fibrous rings after prior BMGU at our center between 2009-2021. We recorded clinical characteristics such as stricture location relative to the buccal graft (proximal, middle, distal), time from BMGU to DVIU in months, and etiology. Primary endpoint was retreatment-free survival after salvage DVIU. Kaplan-Meier analysis was performed for censoring and subsequent treatment modalities in the case of recurrence after salvage DVIU were extracted. RESULTS: Overall, 105 patients underwent DVIU after BMGU for bulbar (66%), penobulbar (16%), penile (15%), or membranous stricture (2.9%). 45% of strictures were proximal of the graft, 43% distal, and 12% were located in a middle position or both proximal and distal of the graft. The majority of strictures were iatrogenic (67%), followed by idiopathic (13%), inflammatory (9.6%), and posttraumatic etiology (7.7%). Median time from BMGU to salvage DVIU was 10 mo (IQR 4.2-28). 13 men (12%) were lost to follow-up and at a median follow-up of 74 mo (IQR 32-127), 53 men (58%) suffered from stricture recurrence (median time to recurrence: 15 mo [IQR 5.0-41]). 12-mo retreatment-free survival was 86%, 82%, and 70% for proximal, distal, and middle/both proximal+distal stricture position, respectively (p=0.1; Figure 1). In patients recurring after salvage DVIU, most subsequent interventions consisted of redo BMGU (46%) and redo salvage DVIU (31%). CONCLUSIONS: Salvage DVIU for veil-like, short segment recurrences remains a limited but viable endoscopic treatment option after anterior BMGU. Pending larger multi-institutional validation, the benefit of DVIU appears more pronounced for anastomotic rings developing at the distal edge of the buccal graft. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1135 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dejan K. Filipas More articles by this author Roland Dahlem More articles by this author Phillip Marks More articles by this author Tim A. Ludwig More articles by this author Silke Riechardt More articles by this author Margit Fisch More articles by this author Malte W. Vetterlein More articles by this author Expand All Advertisement PDF downloadLoading ...

MP42-04 A NOMOGRAM TO PREDICT RECURRENT STRICTURE IN PATIENTS AFTER UPPER URINARY TRACT RECONSTRUCTION SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP42-04 A NOMOGRAM TO PREDICT RECURRENT STRICTURE IN PATIENTS AFTER UPPER URINARY TRACT RECONSTRUCTION SURGERY Wei Zuo, Xinfei Li, Zhihua Li, Kunlin Yang, Qi Tang, Hongjian Zhu, Peng Zhang, Bing Wang, Yaming Gu, Yingzhi Diao, Liqun Zhou, and Xuesong Li Wei ZuoWei Zuo More articles by this author , Xinfei LiXinfei Li More articles by this author , Zhihua LiZhihua Li More articles by this author , Kunlin YangKunlin Yang More articles by this author , Qi TangQi Tang More articles by this author , Hongjian ZhuHongjian Zhu More articles by this author , Peng ZhangPeng Zhang More articles by this author , Bing WangBing Wang More articles by this author , Yaming GuYaming Gu More articles by this author , Yingzhi DiaoYingzhi Diao More articles by this author , Liqun ZhouLiqun Zhou More articles by this author , and Xuesong LiXuesong Li More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent ureteral stricture was relatively common in a small number of patients after upper urinary tract reconstruction. It has been reported that many factors may affect the success rates. However, none of them reached a consensus toward the prediction of ureteral stricture recurrence. The aim was to build a useful and practical nomogram for predicting the recurrence of stricture patients after upper urinary tract reconstitution surgeries. METHODS: We studied a retrospective cohort of 237 patients diagnosed with hydronephrosis and received upper urinary tract reconstruction surgery from 2017 to 2021. We developed the nomogram from a derivation cohort including 134 patients from one center. The validation cohort involved 103 patients from other three centers. RESULTS: In the multivariate analysis of the derivation cohort, three candidate predictors were entered into the final prognostic model: the ratio of postoperative urea nitrogen to preoperative urea nitrogen (p=0.026, HR=0.025), time of removing DJ tube after operation (p=0.049, HR=0.234), preoperative severe hydronephrosis (p<0.0001, HR=6.518), which was developed as a best-simplified nomogram for 1-year prognosis, named as HDU. The model had good predictive ability with a C-index of 0.811. The HDU model had an area under the curve of 0.886 in the internal derivation cohort and 0.718 in the external validation cohort. The calibration plots showed a good agreement between the predicted and observed outcomes in both derivation cohort and validation cohort. CONCLUSIONS: The nomogram HDU showed good predictive ability through internal validation and external validation, as a methodological exploration on the path to accurate prediction for recurrent stricture after upper urinary tract reconstruction surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e567 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wei Zuo More articles by this author Xinfei Li More articles by this author Zhihua Li More articles by this author Kunlin Yang More articles by this author Qi Tang More articles by this author Hongjian Zhu More articles by this author Peng Zhang More articles by this author Bing Wang More articles by this author Yaming Gu More articles by this author Yingzhi Diao More articles by this author Liqun Zhou More articles by this author Xuesong Li More articles by this author Expand All Advertisement PDF downloadLoading ...

Lasertechniken in der Behandlung des benignen Prostatasyndroms

Laser Techniques in the Treatment of Benign Prostatic Syndrome Abstract: Lasers have a wide range of applications in endourological therapy. Not only in the treatment of stones, but also in the treatment of benign prostatic syndrome (BPS), their importance continues to grow. The endourological treatment of BPH with different laser techniques will be discussed in more detail in the following. The physical differences between the individual lasers will be explained first, followed by the treatment options that can be performed with a laser. The main focus will be on the concrete comparison of the treatment methods, especially in clinical contexts. In particular, the duration of surgery, length of hospitalisation, risk of post-operative bleeding, catheterisation duration, risk of urinary retention and risk of post-operative complications such as retrograde ejaculation, bladder neck sclerosis, urethra stricture and adenoma recurrence will be listed and compared for the most important methods. Nevertheless, the distribution of TURP to laser is still 30:1 in favour for TURP [1].