Treatment Of Urethral Strictures Research Articles

Магнитно-резонансная томография в диагностике стриктуры уретры.

Introduction. In order to improve the results of surgical treatment of urethral stricture in men, it is extremely important to accurately diagnose preoperative changes. From this point of view, it seems promising to use magnetic resonance imaging (MRI) in the urethral stricture diagnosis, the assessment of which is the subject of this literature review. Materials and methods. The review is based on articles published throughout history in scientific peer-reviewed journals included in the databases PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), Scopus (https://www.scopus.com/), Scientific Electronic Library eLibrary.ru (https://elibrary.ru/). The search was performed on the following keywords: «magnetic resonance imaging», «MRI», «urethral stricture», «urethral obliteration», «urethral stenosis», «urethral injury», «urethral distraction defect», «urethroplasty», «urethral reconstruction», «urethral surgery», «pelvic fracture». At the first stage, 308 sources were found, of which 23 articles were included in the review. Results. A total of 23 original studies were identified in which MRI was used for urethral stricture in men, of which 2 were Russian studies. Four studies evaluated only anterior urethral strictures, 10 studies evaluated posterior urethral strictures, and 9 studies – both anterior and posterior urethral strictures. These studies included 10 to 121 patients with urethral stricture (mean 42 patients). MRI generally provides more accurate information on the extent of the stricture, the nature of spongiofibrosis and other periurethral changes, the presence of concomitant pathology compared to traditional methods for diagnosing urethral stricture. Conclusions. MRI for urethral stricture provides additional information for treatment planning. However, given the high cost of the method and a small number of works, further research is needed to obtain sufficient grounds for the widespread clinical use of MRI in urethral stricture.

Efficacy of Urethral dilatation with Uttarbasti in the management of Recurrent Urethral Stricture-A Single Case Study

Urethral stricture disease is the common problem occurred in the patients after chronic urinary tract infection, urethral injury or post-surgical interventions performed through per urethra. In Ayurvedic literature urethral stricture may be correlated as mutrotsanga mentioned in Sushruta Samhita. There are advance surgeries available as the science advances with technology various surgeries like Urethroplasty, Visual Internal Urethrotomy, and Dilatation of urethra. The way to overcome this problem is surgery i.e. urethroplasty. But the recurrence rate is high enough to think the alternative. In this case study, 40 years old Male patient suffering from recurrent urethral stricture was came to Shalya Tantra OPD. Patient also undergone repeated urethral dilatations two times but not relieved. So after clinical examination and investigations the case diagnosed as urethral stricture and treated with Ayurvedic Para-surgical procedure i.e uttarbasti to avoid recurrent urethral stricture. In Ayurvedic literature Uttarbasti is the procedure in which some medicinal preparations are introduced per urethra. (As per reference given in sushruta samhita) Uttarbasti was done at 3 days interval for 4 weeks. In this particular study urethral dilatation done by urethral dilatators After that Uttarbasti has been given. After 3rd sitting patient got 70% relief. Thus we can conclude that uttarbasti can be considered as a golden choice of treatment for urethral stricture in Ayurved.

Feasibility and Outcomes of Temporary Bulbar Urethral Stent Placement After Internal Urethrotomy in the Largest Multicenter Series

BackgroundRecent years have seen the development of a new generation of temporary urethral stents as an adjuvant option after direct vision internal urethrotomy (DVIU). Despite some early promising results, large series addressing their safety and outcomes are still lacking. ObjectiveTo report complications and outcomes from the largest series of patients receiving a temporary bulbar urethral stent to date. Design, setting, and participantsWe performed a retrospective analysis of bulbar urethral stenting procedures after DVIU in seven centers. Patients either refused urethroplasty or were not fit for surgery. The stents were removed after at least 6 mo in place unless complications requiring earlier removal occurred. Surgical procedureDVIU with a cold knife or laser is performed, followed by stent placement. At the end of the treatment period, the stent is removed under cystoscopy with gripping forceps. MeasurementsAll patients underwent postoperative follow-up (FU) for assessment of complications while the stent was in place. After removal, the FU schedule consisted of office evaluation at 6 mo and 12 mo, and then annually. Failure was defined as any treatment for urethral stricture after stent removal. Results and limitationsA total of 49% of the patients experienced complications. The most frequent were discomfort (23.8%), stress incontinence (17.5%), and stent dislocation (9.8%). Some 85% of the adverse events observed were Clavien-Dindo grade <3. The overall success rate at median FU of 38.2 mo was 76.9%. The success rate was significantly lower if the stent was removed before 6 mo (53.3% vs 79.7%; p = 0.026). ConclusionsTemporary urethral stents may be a safe choice with satisfactory results in patients not undergoing urethroplasty. A stent indwelling time shorter than 6 mo provides worse outcomes that are comparable to those with DVIU alone. Patient summaryWe assessed complications and outcomes after placement of a temporary narrow tube in the urethra after surgery to widen a narrowing of the urethra. The treatment is safe and easily reproducible with satisfactory results. Further studies are needed to confirm our findings.

Comparison of Closure versus Non-closure of Buccal Mucosal Graft Harvesting Site in Urethroplasty.

Background: Buccal mucosal graft is commonly used in substitution urethroplasty for the treatment of anterior urethral strictures. However, the optimal management of the donor site remains a topic of debate. This prospective study aimed to compare the outcomes and morbidity associated with closure versus non-closure of the buccal mucosal graft harvesting site in urethroplasty.&#x0D; Methodology: A total of 60 patients with anterior urethral strictures underwent buccal mucosal urethroplasty. The patients were divided into two groups: group A (non-closure, n=30) and group B (closure, n=30). Post-operative pain, perioral numbness, early return to diet, and swelling of the cheek were assessed and compared between the two groups. Pain was measured using the Visual Analog Scale (VAS), and statistical analysis was performed using appropriate tests.&#x0D; Results: The mean age of the patients was 35.73 ± 13.42 years, and the mean length of the stricture was 58.45 ± 26.87 mm. Post-operative pain scores measured through VAS were comparable between the closure and non-closure groups at different time points. Perioral numbness was observed in 43.33% of the non-closure group and 30.0% of the closure group (p=0.284). Early return to diet was reported in 40.0% of the non-closure group and 70.0% of the closure group (p=0.019). Swelling of the cheek was noted in 53.33% of the non-closure group and 33.33% of the closure group (p=0.118).&#x0D; Conclusion: This study suggests that non-closure of the buccal mucosal graft harvesting site in urethroplasty results in less post-operative pain, early return to diet, and lower perioral numbness. However, it is associated with increased swelling of the cheek. These findings support the use of non-closure as a viable alternative to closure of the buccal mucosal graft harvesting site. Further research with larger sample sizes and longer-term follow-up is warranted to validate these findings and assess additional outcomes such as stricture recurrence and cosmetic outcomes.

(256) Sexual Function and Andrology Parameters in Men after Treatment of Anterior Urethral Strictures with the Optilume Drug Coated Balloon

Abstract Introduction The Optilume Urethral Drug Coated Balloon (DCB) is a novel endoscopic treatment for recurrent male anterior urethral strictures. An important topic of discussion with patients during counseling on treatment options includes the potential affect of treatment on sexual function and fertility. The ROBUST III study was a prospective, randomized study comparing standard of care endoscopic therapy against treatment with the Optilume DCB. Assessments included evaluation of sexual function and andrology parameters. Objective The objective was to study the potential affect of treatment with the Optilume DCB on sexual function and, for younger patients, fertility. Methods A total of 79 men were randomized to receive treatment with the Optilume DCB. Sexual function was assessed via the 15 item International Index of Erectile Function (IIEF) questionnaire. Erectile function, orgasmic function, and overall satisfaction sub-domains were assessed at 3, 6, and 12 months after treatment in patients that were sexually active at baseline. Fifteen additional subjects were enrolled in a non-randomized pharmacokinetic sub-study that included assessments of paclitaxel concentration in semen and sperm quality parameters through 6 months post-treatment. Results Average erectile function and overall satisfaction scores improved from baseline to 12 months post-treatment, while orgasmic function was not changed (Figure). The improvement in satisfaction was statistically significant at 12 months (p=0.003). No adverse events of de novo erectile or ejaculatory dysfunction were reported. Average ejaculate sperm concentration did not change from baseline to 6 months (49 million/mL vs 46.6 million/mL, p=0.88), nor did total spermatozoa per ejaculate (107.2 million vs 104.0 million, p=0.94). Paclitaxel concentration in semen after treatment was maximal at 30 days (2.99 ng/mL) and was reduced near the limit of quantitation of the analytical method by 6 months (0.12 ng/mL). Conclusions Treatment of male anterior urethral strictures with the Optilume DCB did not appear to have an impact on sexual function as measured by the IIEF and adverse event assessments. Average sperm quality parameters did not differ from baseline to 6 months post-treatment. Low levels of paclitaxel were detected in semen after treatment but were nearly undetectable by 6 months. Disclosure Yes, this is sponsored by industry/sponsor: Urotronic Inc. Clarification Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Sci, Coloplast, Medtronic USA Inc., PROCEPT BioRobotic Corporation, NeoTract Inc., Janssen Biotech Inc., Endo Pharmaceuticals Inc., Tolmar Pharmaceuticals, Inc., 180 Medical Inc., AbbVie Inc., Pfizer Inc., Bluewind Medical, Astellas Pharma US Inc., Antares Pharma Inc., Axonic Modulation Technologies Inc., Allergan Inc., Terumo Medical Corporation, Dendreon Pharmaceuticals llc, Blue Earth Diagnostics Limited, Ferring Pharmaceuticals Inc., Olympus America Inc., Karl Storz Endoscopy-America, Clovis Oncology Inc., Dornier MedTech America Inc., Travere Therapeutics Inc., Valeant Pharmaceuticals North America LLC

Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment

BackgroundThis study aimed to compare the clinical outcomes of non-transecting urethroplasty and lingual mucosal urethroplasty in the treatment of iatrogenic bulbar urethral stricture.ResultsA total of 25 patients with iatrogenic bulbar urethral stricture were enrolled, 12 of whom underwent lingual mucosal urethroplasty, 13 patients who underwent non-transecting urethroplasty. All patients were followed-up and evaluated at 3 postoperative months. Evaluations included urethrography, maximum urine flow rate (Qmax), nocturnal erectile function testing, International Index of Erectile Function (IIEF-5) assessment, and Anxiety Related Scale (SAS) assessment. In terms of operation time, there was a significant difference between non-transecting urethroplasty and lingual mucosal urethroplasty. However, there was no significant intergroup difference in intraoperative blood loss. Both techniques were associated with significantly improved Qmax relative to preoperative rates, but there was no significant difference between the groups in this regard over 3 months of postoperative follow-up. Nocturnal penile tumescence and rigidity results showed that there was no significant change in tip hardness after surgery in the non-transecting urethroplasty group. Moreover, IIEF-5 scores indicated that there was no significant intergroup difference in terms of subjective postoperative erectile function. According to the preliminary psychological evaluations during postoperative follow-up, the anxiety scores of patients undergoing non-transecting urethroplasty significantly improved, but there was no significant change in the mean SAS score among patients who underwent lingual mucosal urethroplasty.ConclusionBoth surgical methods can achieve the clinical goal of treating iatrogenic bulbar urethral stricture. Non-transecting urethroplasty has the characteristics of short operation time, relative technical simplicity, and retention of the original erectile function of most patients, and the surgical outcomes of non-transecting urethroplasty are not inferior to those of lingual mucosal urethroplasty, and it is a promising technique for widespread use to treat bulbar urethral strictures.

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.

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.

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.

MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY

You have accessJournal of UrologyCME1 Apr 2023MP60-16 DORSAL/ DORSO-LATERAL ONLAY BUCCAL MUCOSAL GRAFT VERSUS VENTRAL ONLAY LOCAL PENILE SKIN FLAP IN COMPLEX ANTERIOR URETHRAL STRICTURES; A PROSPECTIVE RANDOMIZED STUDY Ahmed Tawakol, Mohammed Abdel-Rassoul, Mohamed Abdelwahab, Mohamed Elghoneimy, Ahmed Y. Abdelaziz, Ahmed Rammah, Mohamed Elgammal, and Amr Elkady Ahmed TawakolAhmed Tawakol More articles by this author , Mohammed Abdel-RassoulMohammed Abdel-Rassoul More articles by this author , Mohamed AbdelwahabMohamed Abdelwahab More articles by this author , Mohamed ElghoneimyMohamed Elghoneimy More articles by this author , Ahmed Y. AbdelazizAhmed Y. Abdelaziz More articles by this author , Ahmed RammahAhmed Rammah More articles by this author , Mohamed ElgammalMohamed Elgammal More articles by this author , and Amr ElkadyAmr Elkady More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anterior urethral stricture is a challenging disease. Multiplicity of surgical techniques denotes that none is ideal. Our aim is to compare the use of buccal mucosal grafts (BG) versus local penile skin flaps (PF) in patients with complex anterior urethral strictures regarding success rates and complications. METHODS: A total of 34 adult patients with complex anterior urethral stricture were included. A complex anterior urethral stricture was defined as a stricture length of>2 cm and/or previous failed procedures, including urethral dilatation, internal optical urethrotomy and urethroplasty. We randomized patients to undergo either buccal mucosa dorsal/ dorso-lateral onlay graft or ventral onlay local penile skin flap urethroplasty. We compared operative time, estimated blood loss, complications, and succcess rates in both groups. Successful treatment outcome was defined as no further treatment of the urethral stricture required after urethroplasty and peak flow rate>15 ml/s. RESULTS: Mean follow up was 22.3 months in BG group vs 18.9 months in PF group. The site of the stricture, the median stricture length (40 mm in BG group Vs. 50 mm in PF group) and mean operative time were not statistically different between the two groups. Estimated blood loss was higher in PF group (median 400 ml and 300 ml in PF and BG group respectively, p=0.003); statistically significant but clinically insignificant.Two patients (11.8%) in each group developed wound infection. In PF group, one patient (5.9%) had urinary fistula, and one patient (5.9%) presented by mild ventral chordee post operatively. The success rates in the buccal mucosal and penile flap groups were similar (88.2%). CONCLUSIONS: Dorsal/ dorso-lateral onlay buccal mucosal graft and ventral onlay penile skin flap urethroplasty provided similar success rates. Complications were higher in the penile skin flap group. Both techniques can be used for the treatment of complex anterior urethral strictures with good outcome based on the surgeon's expertise. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e849 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Tawakol More articles by this author Mohammed Abdel-Rassoul More articles by this author Mohamed Abdelwahab More articles by this author Mohamed Elghoneimy More articles by this author Ahmed Y. Abdelaziz More articles by this author Ahmed Rammah More articles by this author Mohamed Elgammal More articles by this author Amr Elkady 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 ...

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 ...

MP78-01 EFFECT OF URETHRAL STRICTURE AUA GUIDELINES ON NATIONAL TRENDS IN RECONSTRUCTIVE MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023MP78-01 EFFECT OF URETHRAL STRICTURE AUA GUIDELINES ON NATIONAL TRENDS IN RECONSTRUCTIVE MANAGEMENT Samuel Sorkhi, Sirpi Nackeeran, Michael Witthaus, Jill Buckley, and M. Raj Rajasekaran Samuel SorkhiSamuel Sorkhi More articles by this author , Sirpi NackeeranSirpi Nackeeran More articles by this author , Michael WitthausMichael Witthaus More articles by this author , Jill BuckleyJill Buckley More articles by this author , and M. Raj RajasekaranM. Raj Rajasekaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral Stricture Disease (USD) is a pathological narrowing of the urethra that often results in lower urinary tract symptoms (LUTS), urinary incontinence, urinary tract infections, and ultimately progression toward acute urinary retention. In 2016, the AUA released guidelines on urethral stricture management, focusing on the importance of an earlier transition to urethroplasty rather than repeat endoscopic procedures. This study aims to analyze the recent trends in male urethral stricture treatment from 2016-2020 to determine the impact of the AUA’s most recent guidelines on male urethral stricture management. METHODS: We utilized electronic health record data stored within the TriNetX Research Network to conduct a retrospective analysis of procedures performed between 2016-2020 (a total of 78,532 procedures). Rates of direct visual internal urethrotomy (DVIU), urethral dilation, dilation+DVIU, and urethroplasty were analyzed using chi-square analysis to assess linear trends. RESULTS: The dilation+DVIU group showed a significant increase in procedure rates between 2016-2017 (p=1.269E-08), 2016-2018 (p=5.08E-07), 2016-2019 (p=2.7637E-31), and 2018-2019 (p=5.38E-13; Figure 1A-B). While 2019-2020 showed a decrease (p=4.792E-06), an analysis of the overall trend from 2016-2020 demonstrated no significant difference (p=0.07739). Urethroplasty was offered to younger patients when compared to urethral dilation/incision (Figure 1C) performed in older patients. Repeat dilation/incisions were performed at significantly (22%) higher rates when compared to urethroplasty (Figure 1D). CONCLUSIONS: Despite AUA recommendations encouraging reconstructive surgeons to offer urethroplasty instead of repeated endoscopic interventions, our results suggest no significant change in the rates of these procedures after the release of the 2016 AUA urethral stricture guidelines. The lack of clinical modification may reflect the lag-time incorporating guideline recommendations or practice barriers to implementation. Source of Funding: UCSD Academic Senate © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1131 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Sorkhi More articles by this author Sirpi Nackeeran More articles by this author Michael Witthaus More articles by this author Jill Buckley More articles by this author M. Raj Rajasekaran More articles by this author Expand All Advertisement PDF downloadLoading ...

Erectile function evaluation in patients after urethroplasty: systematic review and meta-analysis

Background. The success of surgical treatment of urethral strictures is often assessed in terms of the quality of urination and the patency of the urethral lumen. Despite the fact that this assessment is carried out according to the above parameters, it seems important to take into account such a possible complication as erectile dysfunction, which can significantly impair the patient’s quality of life. This is the difference in the perception of the success of the surgical intervention by the clinician and the patient.Aim. To determine the relationship between urethroplasty and the likelihood of erectile dysfunction in the postoperative period according to world literature.Materials and methods. The PubMed database was analyzed using the keywords: anterior urethroplasty, posterior urethroplasty, urethroplasty, sexual dysfunction, erectile dysfunction. All articles were reviewed by two independent authors for inclusion based on predetermined criteria. Among the included scientific papers are randomized controlled trials, systematic reviews.Results. Sixteen scientific papers with a total of 1476 patients were included in the final study. The decrease in erectile function after surgery in this meta-analysis is 3 %. The main factors influencing postoperative parameters were age and erectile function at the time of surgery.Conclusion. Most studies state that urethroplasty does not imply a significant impact on erectile function, however, they acknowledge that the occurrence of this complication affects the assessment of treatment outcomes among patients and the further impact on their quality of life, regardless of postoperative urinary function.

Minimally invasive techniques of urethral stricture treatment and their use in patients of pediatric age (literature review)

Urethralstricture remains one of the most discussed problemsin pediatric urology. Despite a significant number of articles and the existence of a wide variety of methods for treating urethral strictures and their modifications, every new generation of urologists encounters this problem.Treatment of urethralstricture often takes a long time and requires multiple surgical interventions. Treatment techniques continuously improve, therefore it is appropriate to regularly summarize new data. Such methods as bougienage, balloon dilation and urethralstenting are still being used, although as early asin the beginning of the 19th century the first types of such modern method as optical internal urethrotomy were developed. In relation to optical internal urethrotomy, discussions on indications, techniques, duration of catheterization, necessity of combination with intermittent catheterization, use of hormonal drugs continue. The question of the number of attempts to perform urethrotomy also remains controversial.In this review, we tried to clarify the problem of use of minimally invasive techniques for urethral stricture treatment in children in the context of current scientific data and historical aspects.

Comparative evaluation of 90-day patient outcomes and healthcare encounters following extended day surgery urethroplasty.

Most centers have shifted to an extended day surgery (XDS ) model for urethroplasty. Our study characterizes outcomes and unplanned healthcare encounters of patients undergoing XDS urethroplasty compared to case-matched inpatient controls. We conducted a retrospective, two-surgeon, single-center study of patients undergoing XDS urethroplasty (discharge <24 hrs) from November 2020 to November 2021. Patients were case-control matched based on age, stricture length, location, and etiology to patients who had previously undergone inpatient urethroplasty. Data was analyzed using descriptive and univariable statistics. Multivariable analysis by Cox proportional hazard regression was used to identify associations with postoperative complications. Ninety patients (mean age=53.8 years) underwent XDS urethroplasty during the study period. Mean stricture length was 4.4 cm (standard deviation [SD ] 2.4). Rates of postoperative complications were similar between XDS (17%, n=15) and admitted patients (21%, n=19), and XDS was not associated with increased risk on univariable analysis (odds ratio [OR ] 0.65, 95% confidence interval [CI] 0.31-1.3, p=0.36). When stratifying by location, penile stricture (OR 4.21, 95% CI 1.3-13.8, p=0.02) and lichen sclerosus (OR 2.91, 95% CI 0.79-9.9, p=0.08) were associated with increased risk of postoperative complication. On multivariable analysis, only penile stricture was identified as significant (OR 4.78, 95% CI 1.2-19.4, p=0.03). Forty-eight percent (n=43) of patients had unplanned healthcare encounters postoperatively, with similar numbers of phone calls (n=37) and emergency department visits (n=36) between groups. Our study shows that XDS urethroplasty is not associated with increased rates of complications relative to inpatient admission. This data supports using an XDS pathway for resource-efficient treatment of urethral strictures in a universal healthcare setting.

The surgical techniques of transperineal anastomotic urethroplasty for complex posterior urethral stenosis in boys and the long-term follow up outcomes.

To explored the curative effects of various surgical methods used to treat complicated posterior urethral strictures in boys and the long-term complication. We retrospectively studied 28 boys under 14 years of age with complicated posterior urethral strictures treated at our hospital from January 2015 to December 2020. Urethral angiography revealed posterior urethral strictures. Twelve had previously failed urethral surgery; four had urethral fistulae. All underwent end-to-end urethral anastomoses via a transperineal, inferior pubic approach. We freed the distal end of the urethra, split the penile cavernous septum, partially resected the lower edge of the pubic symphysis, and rerouted the urethra under a corpus cavernosum to reduce the tension of the urethral anastomosis. All boys were 2-14 years of age at the time of surgery (mean 6.3 years). The urethral strictures were 3-5.5 cm in length (mean 4.2 cm). Catheters were removed 4 weeks postoperatively. The postoperative follow-up time was 4-72 months (mean 36.8 months). Twenty-four patients exhibited unobstructed urination after a single operation. The maximum urinary flow rate was 15-22 ml/s (average 17.8 ml/s); the success rate was 85.7%. Two patients required second urethral end-to-end anastomoses; urination became normal postoperatively. Two continued to exhibit cystostomies, and two evidenced mild incontinence. Of the six children who have attained puberty, two report erectile dysfunction. End-to-end urethral anastomosis via a transperineal inferior pubic approach is an ideal treatment for posterior urethral strictures in boys. The complications include incontinence and erectile dysfunction, and require long-term follow-up.

Combining Transurethral Resection of Fibrous Tissue and Temporary Urethral Stent Insertion Is an Optimal Strategy for Minimally Invasive Treatment of Recurrent and Long Urethral Strictures

This study investigated the optimal strategy for the treatment of chronic recurrent urethral strictures longer than 3 cm, using a temporary urethral stent. Between September 2011 and June 2021, 36 patients with chronic bulbomembranous urethral strictures underwent temporary urethral stent placement. Retrievable self-expandable polymer-coated bulbar urethral stents (BUSs) were placed in 21 patients (group A), and thermo-expandable nickel-titanium alloy urethral stents were placed in 15 patients (group M). Each group was subdivided into those with and without transurethral resection (TUR) of fibrotic scar tissue. The urethral patency rates at 1 year after stent removal were compared between the groups. The patients in group A showed a higher urethral patency maintenance rate at 1 year after stent removal than those in group M (81.0% vs. 40.0%, log rank test p = 0.012). Analysis of subgroups in which TUR was performed due to severe fibrotic scar, showed that the patients in group A showed a significantly higher patency rate than patients in group M (90.9% vs. 44.4%, log rank test p = 0.028). In the treatment of chronic urethral strictures with a long fibrotic scar, temporary BUS combined with TUR of fibrotic tissue seems to be the optimal minimally invasive treatment strategy.

Outcomes of HUD Versus CIC in Patients With Urethral Strictures.

Treatment of urethral stricture is a complex reconstructive urology treatment. Previous surgery in the treatment of urethral stricture increases the risk of urinary incontinence. Therefore, this study aimed to assess the outcome of comparing two preservative or nonsurgical methods, clean intermittent catheterization (CIC) or hydraulic urethral dilatation (HUD). Forty-eight patients diagnosed with symptomatic urethral stricture were enrolled in the study. Patients were randomly divided into two groups: Nelaton-based dilatation and HUD treatment. Patients were assessed using patient-reported outcome measure for urethral stricture surgery (USS-PROM) through direct clinical interview and were followed up for 12 months. The rate of urinary infection, the need for surgical intervention, and the patient's quality of life were considered as outcomes of the interventions. SPSS software, version 20.0, was used for statistical analysis. Overall, 23 (47.9%) patients underwent HUD of stricture and Nelaton-based dilatation of stricture was done in 25 (52.1%) patients. We found that surgical intervention was required in four patients in the HUD group, but 15 patients in the CIC group required surgical intervention. Also, the need for surgical intervention and urinary tract infection (UTI) was significantly greater in the CIC group compared with the HUD group. With respect to the patient-reported outcomes, the mean Peeling's voiding picture (Q8) and EQ-VAS score (Q16) in the HUD group (p = .02) were significantly greater than those in the CIC group (p = .02). We obtained excellent results by using an HUD catheter. This safe, simple, well-tolerated, home-based procedure reduced the need for hospital admission to operate for repeat.