Treatment Of Urethral Strictures Research Articles

A multimodality review of male urethral imaging: pearls and pitfalls with an update on urethral stricture treatment.

Optimum radiological assessment of the male urethra requires knowledge of the normal urethral anatomy and ideal imaging techniques based on the specific clinical scenario. Retrograde urethrography is the workhorse examination for male urethral imaging, usually utilized as the initial, and often solitary, modality of choice not only in the setting of trauma, but also in the pre- and post-operative evaluation of urethral strictures. There is, however, growing interest in utilization of ultrasound and magnetic resonance for evaluation of the male urethra owing to lack of ionizing radiation and improved delineation of the adjacent tissue. We review the various modalities utilized for imaging of the male urethra for a variety of known or suspected disorders, and provide an update on current treatments of urethral strictures. Additionally, we detail the key information needed by urologists to guide management of urethral strictures. We conclude with a brief discussion of neophallus urethral diseases following female-to-male sexual confirmation surgery.

V02-10 LONG TERM EVALUATION OF THE ARGUS-T® ADJUSTABLE MALE SLING: A PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 May 2022V02-10 LONG TERM EVALUATION OF THE ARGUS-T® ADJUSTABLE MALE SLING: A PROSPECTIVE STUDY Rafael Zanotti, André Costa Matos, Felipe Pinho, Claudio Hideki Toi, Sergio Paolillo, Giovani Demartino, Marcel Takada, Bruno Hirata, and Luís Gustavo Morato de Toledo Rafael ZanottiRafael Zanotti More articles by this author , André Costa MatosAndré Costa Matos More articles by this author , Felipe PinhoFelipe Pinho More articles by this author , Claudio Hideki ToiClaudio Hideki Toi More articles by this author , Sergio PaolilloSergio Paolillo More articles by this author , Giovani DemartinoGiovani Demartino More articles by this author , Marcel TakadaMarcel Takada More articles by this author , Bruno HirataBruno Hirata More articles by this author , and Luís Gustavo Morato de ToledoLuís Gustavo Morato de Toledo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male slings are attractive alternatives for the treatment of post prostatectomy urinary incontinence (PPI). In this study and accompanying video, our purpose is to report our findings of up to 12 years of follow up and the technical details that led us to our results. METHODS: From 06/2009 to 09/2021, 89 patients with PPI underwent male Argus-T® adjustable sling implantation. We prospectively recorded their data.Prior to implantation and during follow up, patients were acessed through clinical evaluation, 24h pad-test, ICIQ-SF and complications. Clinical and urodynamic variables were correlated to the need for readjustments. Success was defined by cure or improvement. The definition of objective cure was dry patient; of improvement, decrease >50% number of pads; of fail, decrease <50% number of pads. The definition of subjective cure was VAS >=8 and PGI-I “much better”; of improvement, VAS 6-7 and PGI-I “little better”; of fail, VAS <=5 or unchanged. RESULTS: The median follow up was 96 (13 - 144) months. In our series 22 patients (24,6%) had mild, 23 (26,1%) moderate and 44 (49,3%) severe incontinence. 20 patients (22,5%) had received previous radiotherapy and 18 (19,7%) previous urethral stricture treatment. Within the whole series, 75 patients (85,4%) achieved subjective success (74,4% cure + 11% improvement) and 71 (80,5%) objective success (65,9% cure + 14,6% improvement). Readjustments were necessary in 23 (25,8%) cases. Considering only the subgroups of patients who received previous radiotherapy and/or previous urethral stricture treatment, 66,7% needed readjustments. We found that these are predictor factors for the need of readjustments (p 0,001). Complications included: 2 cases of protusion of silicon arms to the scrotal skin; 2 of inguinal granuloma. 7 cases of urinary retention that resolved with indwelling catheter for 7 to 10 days. Device removal was necessary in 5 cases, 4 due to infection and 1 due to persistent urinary retention and severe pain. No cases of device components explantation were reported. Curiously, 3 of the 5 patients who had their devices removed remained dry, removal occurred about 2 years after surgery. CONCLUSIONS: We found similar success rates than previously published for this device, however adverse events are lower, especially regarding to sling removal. Previous radiotherapy and urethral stricture treatment are predictor factors for the need for readjustments. Adjustability benefits a significant number of patients who would have failed. Especially those with worse prognostic factors; maintaining the success rates of this group similar to the group without these factors. Argus-T has high and maintained success rate. Good outcomes can be achieved even for moderate to severe incontinence cases. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e113 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rafael Zanotti More articles by this author André Costa Matos More articles by this author Felipe Pinho More articles by this author Claudio Hideki Toi More articles by this author Sergio Paolillo More articles by this author Giovani Demartino More articles by this author Marcel Takada More articles by this author Bruno Hirata More articles by this author Luís Gustavo Morato de Toledo More articles by this author Expand All Advertisement PDF DownloadLoading ...

Use of Temporary Membrane-Covered Self-Expandable Metallic Stent - UVENTATM for Treatment of Recurrent Bulbar Urethral Stricture.

IntroductionRecurrent urethral stricture is a real challenge. Interestingly use of temporary double layered self-expanding nitinol urethral stent with polytetrafluoroethylene (PTFE) membrane coating (UventaTM, Taewoong Medical, South Korea) has been recently reported with promising short-term results in recurrent urethral stricture. However most of the reported studies are published as abstracts of either case reports or case series of miniscule numbers. The aim of our study is to evaluate the outcome of this temporary urethral stent in patients with recurrent urethral stricture after urethroplasty as well as after multiple visual internal urethrotomy.Materials and MethodsIn this retrospective study, 22 patients had placement of double-layered self-expanding stent with PTFE membrane coating (Uventa, Taewoong Medical) for recurrent bulbar strictures. The present study included cases between 2017 and 2020. The stricture in each patient were evaluated with Uroflowmetry and ascending urethrography. The data of demographic and clinical characteristics included age, aetiology, location and length of stricture, along with maximum urinary flow rate (Qmax), number of previous interventions, and stent-related complications.ResultsThe overall clinical success was achieved in 13/22 (59.1%) of patients at a median follow-up of 17 months (range 2–44). The mean maximum urine flow rates were 7.07 ± 3.55mL/sec, 23.50 ± 10.41mL/sec, 21.41± 15.55 mL/sec, 14.88 ± 9.77 and 17.63 ± 12.28 mL/sec before, while stent in place, at 3 months, 6 months and 12 months after the procedure, respectively. ConclusionIn our study, the success rate of temporary urethral stent placement has remained at 59.1% at a median follow-up of 17 months. We conclude that further randomized controlled studies with long-term follow up are required to fully evaluate the outcome.

Prevalent Practices in Male Anterior Urethral Stricture Management: A Survey

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

Early Data Supporting Ventral Onlay Pseudospongioplasty for Penile Urethral Strictures

ABSTRACT Introduction Augmented urethroplasty with buccal mucosal graft remains one of the mainstays of urethral stricture management, and location of graft placement depends on surgeon preference as well as patient-specific factors. Historically, ventral graft placement has been preferred in the bulbar urethra due to a robust blood supply provided by a thicker corpus spongiosum at the bulb. While, in the penile urethra, dorsal placement is traditionally preferred due to limited spongiosum in this location and concern for poor graft take. Some have advocated for ventral onlay placement in the penile urethra, arguing this placement decreases dissection thereby preserving vascularization of the urethra. We present promising results and outcomes for ventral onlays in the penile urethra, which we cover with periurethral vascularized tissue as a “pseudospongioplasty” to provide a supportive, vascular bed for graft survival. Objective We aimed to assess the efficacy of ventral buccal mucosal graft positioning for treatment of penile urethral strictures using the pseudospongioplasty technique. Methods We retrospectively reviewed clinical and procedural characteristics for all patients that underwent urethroplasty at our institution from August 2016 through February 2021. Patients were divided into one of three groups based on their operative approach: (1) pseudospongioplasty in the penile urethra, (2) spongioplasty in the bulbar urethra, (3) and bulbopenile strictures requiring a combined approach. Key outcomes variables included recurrence rates and complication rates. Results 50 patients fit our inclusion criteria. We identified 18 patients that underwent isolated spongioplasty in the bulbar urethra, 19 patients that underwent isolated pseudospongioplasty in the penile urethra, and 13 patients with bulbopenile strictures that had simultaneous spongioplasty and pseudospongioplasty. All procedures used buccal mucosa as a ventral onlay. Median stricture length (cm) for spongioplasty, pseudospongioplasty and both were 4.0 (3-5) and 4.25 (3.5-6) and 8 (6-10), respectively. There were three 30-day complications in each group. Figure 1 shows the Kaplan Meier curves for recurrence in the three study groups, rates were not statistically different using spongioplasty as a reference group (p=0.83 and p=0.72 for pseudospongioplasty and combined, respectively). When compared to spongioplasty, the relative risk of recurrence in pseudospongioplasty and combined were 0.41 (0.05-2.44, p=0.344) and 1.56 (0.30-8.21, p=0.593), respectively. Meanwhile the relative risk for complications were 0.94 (0.15-5.77, p=0.942) and 1.5 (0.24-9.61, p=0.657), for pseudospongioplasty and combined respectively. Conclusions Supporting recent literature concerning ventral onlay graft positioning in the penile urethra, a pseudospongioplasty appears to provide enough of a supportive vascular bed for graft survival. There are few published series demonstrating its effectiveness; however, we show that pseudospongioplasty in the penile urethra has comparable outcomes to conventional spongioplasty in the bulbar urethra. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific

The evolution of urethral stricture and urethroplasty practice over 15 years: A single-center, single-surgeon, 1319 urethroplasty analysis.

The management of urethral stricture has evolved over the last several decades. We sought to analyze urethral stricture and urethroplasty trends at a tertiary referral center over a 15-year period. Patients undergoing urethroplasty by a single surgeon from August 2003 to July 2018 were analyzed. Patient demographics, urethroplasty techniques, and outcomes were collected in a prospectively maintained database and were categorized into three five-year tertiles based on date of surgery. These tertiles were subsequently retrospectively analyzed for trends and changes in practice. A total of 1319 urethroplasties were completed over the study period. During the first five years (T1), 299 urethroplasties were performed, with 431 and 589 performed in T2 and T3, respectively. Mean overall patient age was 46.8 years, which increased significantly over time (p<0.001). Idiopathic strictures were most common (n=516, 39.1%) and unchanged over time, while proportionately radiation-induced strictures increased (n=9, 3.0% [T1], n=22, 5.1% [T2], n=51, 8.7% [T3]; p=0.001) as did iatrogenic and lichen sclerosus strictures. Mean stricture length (4.7 cm [T1], 4.8 cm [T2], 4.0 cm [T3]; p<0.001) and the mean number of prior endoscopic procedures (3.4 [T1], 3.9 [T2], and 2.5 [T3]; p<0.001] decreased over time. Single-stage urethroplasty with buccal mucosa was the most common technique performed (n=656, 49.7%) that increased in prevalence (p=0.009), while both flap and staged techniques decreased (p=0.008, p=0.004, respectively). Overall success rate was 90.1% (n=1106), which improved significantly with time (n=248, 86.7% [T1], n=359, 90.0% [T2], n=499, 93.4% [T3]; p=0.001). We observed that patients and treatment of urethral stricture evolved over 15 years in practice, with an increase in patient age, radiation, and iatrogenic and lichen sclerosus strictures, while demonstrating a decrease in stricture length and the number of prior endoscopic procedures performed. Increased use of single-stage urethroplasty using buccal mucosa was observed, which may have contributed to an increase in urethroplasty success over time.

FDA approves the Optilume® urethral drug coated balloon for the treatment of urethral strictures

<scp>FDA</scp> approves the Optilume^® urethral drug coated balloon for the treatment of urethral strictures

A0871 - The multi-stage treatment of complex spongy urethral strictures: Predicting the risk of urethral stricture recurrence

A0871 - The multi-stage treatment of complex spongy urethral strictures: Predicting the risk of urethral stricture recurrence

A0855 - Evaluation of the quality of life of patients with the SF-36 questionnaire when using platelet-rich plasma in the treatment of recurrent urethral stricture

A0855 - Evaluation of the quality of life of patients with the SF-36 questionnaire when using platelet-rich plasma in the treatment of recurrent urethral stricture

IJU this issue

This issue contains one Review Article, nine Original Articles and one Urological Note with three Editorial Comments. Although 2-D cell culture and animal models have been widely used to examine tumor genetics and the sensitivity against anticancer drugs, these methods cannot mimic the tumor microenvironment in human bodies, and accurate analysis of anticancer treatment cannot be carried out. Tse et al. (Hong Kong, China) reviewed the development and applications of 3-D organoid cultures in urological cancer, and assessed the future prospects of this model. In this review, the authors discussed the advantage of organoids in drug screening and personalized medicine, the identification of cells of origin for urological cancers, and the tumor microenvironment. The authors concluded that 3-D organoids would have great potential in urological cancer research. Lin et al. (Kaohsiung, Taiwan) reported the incidence and survival variations of 8830 patients with new diagnoses of upper tract urothelial cancer identified from the Taiwan National Cancer Registry Annual Reports. The status of upper tract urothelial cancer in Taiwan was clarified, and what was interesting was that, in contrast to data from other countries, the incidence of upper tract urothelial cancer was considerably higher in women. Although the authors pointed out the possibility of aristolochic acid exposure as the cause, it is still unclear at this time. Iqbal et al. (New York, USA) reported a propensity score-matched analysis of effects on renal function between continent (neobladder; 50 patients) and incontinent (ileal conduit; 87 patients) urinary diversion. As a result of detailed analysis, the authors concluded that ileal conduits and neobladders showed a similar effect on the estimated glomerular filtration rate up to 5 years after robot-assisted radical cystectomy. To treat urethral stricture, most urologists carry out transurethral treatment. However, stricture recurrence after transurethral treatment is considered to be major problem. In this issue, Ojima et al. (Saitama, Japan) reported a preclinical study on the ability of photocurable gelatin to prevent stricture recurrence after urethral dilation in a rabbit model. The mean lumen ratio differed significantly after dilation between five rabbits with dilation + photocurable gelatin treatment and five rabbits with dilation only (65.5% vs 27.3%). The regenerated urethral epithelium at the stricture site is much better with dilation + photocurable gelatin treatment. I believe that this treatment to prevent stricture recurrence would be attractive from the perspective of showing the possibility of a new minimally invasive treatment for urethral stricture. In the Urological Note, Komai et al. (Tokyo, Japan) presented a proposed protocol for “What should we do next?” in the management of major bleeding during minimally invasive pelvic surgery. I believe that it will be useful clinically, so please take a look at the figure (a protocol for emergent bleeding from veins during minimally invasive pelvic surgery). Unfortunately, the limited space does not allow me to introduce all the articles. However, all the papers are very interesting and informative. So, please enjoy them by all means. None declared.

A0861 - Long-term outcomes of urethral stricture treatment with the Optilume paclitaxel-coated balloon

A0861 - Long-term outcomes of urethral stricture treatment with the Optilume paclitaxel-coated balloon

One-Year Outcomes of the ROBUST II Study Evaluating the Use of a Drug-Coated Balloon for Treatment of Urethral Stricture

Objective To report 1-year results of the ROBUST II study investigating the safety and efficacy of a paclitaxel-coated balloon for the treatment of recurrent urethral strictures. Methods Subjects were adult men with a single anterior urethral stricture ≤ 3 cm in length and at least 2 prior stricture treatments. After treatment with the Optilume urethral drug-coated balloon (DCB), subjects were followed through 1 year. The primary safety endpoint was the rate of treatment-related serious complications at 90 days post-procedure. Efficacy outcomes included symptomatic assessments, erectile function measured using the International Index of Erectile Function (IIEF), Qmax, and anatomic success. Results Sixteen men with an average of 4.1 prior dilations were treated with the DCB. Anatomic success was achieved at 6 months in 73%. Average IPSS improved from 18.4 to 6.0 at 1 year (P &lt; 0.001). Qmax improved from 6.9 mL/sec to 20.8 mL/sec (P &lt; 0.001). There was no change in IIEF. Four subjects received additional treatment within 1 year. There were no treatment-related serious complications. Conclusions Short-term follow-up of men with urethral stricture treated with the Optilume DCB showed durable anatomic results at 6 months and sustained symptomatic improvement through 1 year. Treatment with the device was safe.

To Transect or Not Transect: Results from the Scandinavian Urethroplasty Study, A Multicentre Randomised Study of Bulbar Urethroplasty Comparing Excision and Primary Anastomosis Versus Buccal Mucosal Grafting

BackgroundOpen surgical treatment of short bulbar urethral strictures (urethroplasty) is commonly performed as transecting excision and primary anastomosis (tEPA) or buccal mucosa grafting (BMG). Erectile dysfunction and penile complications have been reported, but there is an absence of randomised trials. ObjectiveTo evaluate sexual dysfunction and penile complications after urethroplasty with tEPA versus BMG. Design, setting, and participantsCentres in Finland, Sweden and Norway participated. Patients with a bulbar urethral stricture of ≤2 cm without previous urethroplasty were randomised. The primary endpoints were the degree of erectile dysfunction and penile complications. Follow-up was 12 mo. InterventionPatients were randomised to either tEPA or BMG urethroplasty. Outcome measurements and statistical analysisSexual dysfunction was measured using the International Index of Erectile Function, 5-item version (IIEF-5) and a penile complications questionnaire (PCQ) designed for this study. Continuous data were analysed using analysis of covariance and categorical data were compared using a χ2 test. Results and limitationsA total of 151 patients were randomised to either tEPA (n = 75) or BMG (n = 76). The tEPA group reported more penile complications (p = 0.02), especially reduced glans filling (p = 0.03) and a shortened penis (p = 0.001). There were no differences in postoperative IIEF-5 total scores. Recurrence rates were similar in both groups (12.9%) but the study was not designed to detect differences in recurrence rates. The PCQ is not validated, which is a limitation. ConclusionsMore patients reported penile complications after urethroplasty with tEPA than with BMG. This should be considered when choosing the operative method, and patients should be informed accordingly. Patient summaryThis study compared two common operations for repair of narrowing of the male urethra. Neither of the two methods seems to cause worsened erections. However, penile problems are more common after the transection technique than after the grafting technique.

Case Report On Urethral stricture

This clinical guideline’s goal is to establish a foundation for detecting and treating male urethral stricture. Resources and procedures: Pubmed, Embase, and Cochrane are three databases that can be used to find information.were searched for peerreviewed literature related urethral stricture: a guide to diagnosis and treatment (search dates 1/1/1990 to 12/1/15). The review produced a data collection of 250 papers after applying inclusion/exclusion criteria. The Guideline statements were based on these publications. Patients’ benefits and risks/burdens were used to produce Strong, Moderate, or Conditional Recommendations When there was inadequate evidence, additional guidance was given Clinical Principles and Expert Opinion are two types of evidence that can be found in the literature. Systems and Important clinical Finding : urination difficulties, straining, or pain, inadequate bladder emptying, pee stream sprayed, need to urinate more frequently or have a stronger urge to urinate. The main diagnose and therapeutic intervention and outcome : The doctor discovered urethral stricture after a physical examination and investigation. After urethral stricture treatment, many patients have a positive outcome. If the stricture is caused by scar tissue, you may need more treatments in the future. Due to a total blockage of the urethra, you are unable to urinate is known as urinary retention.can occur in some circumstances due to stricture. This is a potentially life-threatening situation. If you have signs of a stricture and are unable to urinate, call your doctor straight once. Conclusion : Urethral strictures must be identified and treated early on in order to avoid the most serious long-term consequence, reduced renal function. The high recurrence rate of urethrotomy limits its clinical value. A urethral stricture is a scarring constriction that hinders the lower urinary tract from working correctly. The effects of this obstruction can significantly reduce By causing micturition issues, They can lower a patient’s quality of life and potentially cause renal failure by affecting the entire urine system. As a result, it is critical urethral strictures, which can develop at any age and in any gender, either men or women (though they are far more common in women), are diagnosed and treated as soon as possible

Emergency tactics for the treatment of urethral strictures caused by scleroatrophic lichen

Emergency tactics for the treatment of urethral strictures caused by scleroatrophic lichen

Effect of local steroids on urethral strictures: A systematic review and meta-analysis.

PurposeUrethral stricture disease is common and has high associated morbidity and impact on quality-of-life. This systematic review and meta-analysis aims to summarise current evidence on the efficacy of local urethral steroids post-direct vision internal urethrotomy (DVIU) for the treatment of urethral strictures in males.Materials and MethodsA comprehensive search was performed using reputable databases and registries, up to 22 February 2022. Only randomised control trials in which participants were randomised to DVIU plus local urethral steroids versus DVIU only were included. Statistical analyses were performed using a random-effects model. Quality of evidence was rated according to the GRADE approach.ResultsThe search identified seven studies in which 365 participants were randomised to DVIU plus local urethral steroids versus DVIU only. The application of local steroids appeared to reduce recurrence rates (risk ratio, 0.67; 95% confidence interval [CI], 0.49–0.90) and time-to-recurrence (hazard ratio, 0.58; 95% CI, 0.39–0.85). Qmax also improved following steroid application (mean difference, 0.82; 95% CI, -1.02–2.66); however, this was not statistically significant. No heterogeneity was identified between included studies for all outcomes. The certainty of evidence was downgraded due to study limitations with a small sample size and unclear risk-of-bias related to insufficient trial information.ConclusionsCompared to DVIU alone, adjuvant steroids applied to the urethra may reduce risk of recurrence and time-to-recurrence. These findings were statistically significant and likely also clinically significant given low associated costs and risk. However, more robust randomised trials are necessary to enhance the validity of these outcomes.

Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men

BackgroundSeveral treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the surgical outcomes. AimThe aim of this study was to analyze the surgical outcomes after treatment of urethral strictures and urethral fistulas following metoidioplasty. MethodsA multicenter retrospective cohort study was conducted with transmen treated for strictures and fistulas after metoidioplasty in 3 tertiary referral centers. OutcomesThe primary outcome was the recurrence-free rate after surgical treatment of urethral strictures and urethral fistulas over a time period of 3 years postoperatively. ResultsOf 96 transmen included in this study with a urethral complication, 44 (46%) experienced a urethral fistula, 31 (32%) a urethral stricture, and 21 (22%) both complications simultaneously. The recurrence-free rate for urethral strictures following endoscopic management (ie, urethral dilation or direct visual internal urethrotomy) was 61% after 1, 50% after 2, and 43% after 3 years, compared to 82% following open treatment options after 1, 2, and 3 years (P = .002). Open treatment options were Heineke-Mikulicz procedure (7/9, 78% success), excision and primary anastomosis (3/3, 100%), 2-stage without graft (9/9, 100%), pedicled flap urethroplasty (1/1, 100%), and buccal mucosa graft urethroplasty (2/4 [50%] single-stage, 1/1 [100%] 2-stage). The recurrence-free rate for small urethral fistulas located at the pendulous urethra was 79% after 1, and 72% after 2 and 3 years, compared to 45% after 1, and 41% after 2 and 3 years for large fistulas, generally located at the urethral anastomoses of the fixed urethra. Treatment options for urethral fistulas were fistulectomy (26/48, 54%), fistulectomy & (redo) colpectomy (7/11, 64%), buccal mucosa graft urethroplasty (1/1, 100%), and retubularization of the urethral plate (3/4, 75%). A colpectomy before or during reoperation of a urethral fistula at the proximal urethral anastomosis showed higher success rates compared to without a colpectomy (7/11 [64%] vs 2/13 [15%] respectively, P = .03). Clinical ImplicationsThis study provides insight in the treatment possibilities and corresponding outcomes of urethral complications following metoidioplasty in transmen. Strengths & LimitationsStrengths were the relatively large sample size and the overview of multiple treatment options available. Limitations were the heterogeneity of the cohort, underexposure of some surgical modalities, and absence of patient-reported outcomes. ConclusionOpen surgical techniques show better long-term outcomes in the management of urethral strictures compared to endoscopic options, and a colpectomy is beneficial before or during urethral fistula repair at the proximal urethral anastomosis.de Rooij FPW, Falcone M, Waterschoot M, et al. Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men. J Sex Med 2022;19:377–384.

Промежностная и пенильная уретростомии: хирургический результат и оценка рисков осложнений

Urethral repair in the complex urethral strictures (US) is associated with a high risk of failure. In some cases, urethrostomy is justified when choosing a method of treatment for this category of patients.To assess the results of perineal and penile urethrostomy and identify factors associated with the development of early surgical complications and urethrostomy stenosis (USs).85 patients aged 53.9 years underwent urethrostomy from 2010 to 2019: permanent - 48 (56.5%), due to refusal of urethroplasty - 37 (43.5%). Penile urethrostomy was formed in 41 (48.2%) patients, perineal USs - in 44 (51.8%), respectively. The US etiology was as follows: inflammatory - 32.9%, iatrogenic - 29.4%, idiopathic - 28.2%, traumatic - 9.4%. The US length was 6 cm or more in 58.8% patients, multifocal lesions occurred in 22.4% cases, subtotal - in 28.2%. The criterion for successful treatment was the absence of complications requiring repeated surgery on the urethra and / or systemic bougienage (median follow-up - 58 mo). The contribution of various factors to the increased risk of developing USs was assessed using univariate analysis by calculating the odds-ratio (OR, 95% CI). Statistical significance was tested using the 2 test, Fishers test. Multivariate analysis was performed using logistic regression.Early postoperative complications (EPCs) were detected in 7 (8.2%) patients [urethritis (2), wound phlegmon (2), scrotal hematomas (1), unrecovered urination (1), acute urinary retention (1)]. Of these, only 2 (2.4%) cases required additional surgical intervention. USs was detected in 14 (16.5%) patients during the follow-up period from 3 to 200 mo (median - 8 mo). USs surgical correction was required in 12 (14.1%) cases, systemic bougienage - in 2 (2.4%) cases. Independent risk factors for all complications were UTIs (OR=3.3; 95% CI - confidence interval (CI)=1,17 - 9,1; p=0.013), arterial hypertension (OR=2.3; 95% CI=1.02 - 5.05; p=0.044), bougienage (OR=2.4; 95% CI=1.08 - 5.33; p=0.031), the US multifocal localization (OR=2.8; 95% CI=1.28 - 6.05; p=0.011), and for stenoses, in particular, UTIs (OR=6.1; 95% CI=1.45 - 25.22; p=0.003), arterial hypertension (OR=2.6; 95% CI=1.05 - 6.40; p=0.035), previous hypospadias repair (OR=3.3; 95% CI=1.27 - 8.55; p=0.031) and EPCs (OR=4.1; 95% CI=1.74 - 9.41; p=0.004). The combination of unfavorable factors identified in multivariate analysis determines development from 21.8% to 49.9% cases of early and late complications.Urethrostomy may be the ultimate treatment for spongy complex US with an 82.4% primary success rate. The main factors negatively affecting the surgery outcomes are arterial hypertension, chronic kidney disease, US multifocal localization, previous bougienage, previous hypospadias repair, urethrocutaneous fistulas and EPCs.

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China.

Background: Male urethral stricture is a disease with a high incidence rate. With social-economic development in the developing countries, the trend of etiology and treatment of male urethral stricture changed was speculated.Methods: The clinical data of the male patients with urethral stricture from 2000 to 2019 were analyzed. The subjects were divided into Group A (2000–2009) and Group B (2010–2019) according to treatment time. The pooled analysis of the data extracted from pieces of literature was also performed.Results: About 540 patients were included in the present study, including 235 patients in Group A and 305 patients in Group B. In recent 10 years, trauma has still been the main cause of urethral stricture. Iatrogenic injury, especially transurethral operation, increases significantly, while male urethral stricture secondary to radiotherapy and infection decrease. Urethroplasty increases and the reoperation rate decreases in treating simple urethral stricture, and flap urethroplasty also increases in treating complex urethral stricture. The results of a pooled analysis of data from 11 centers in Mainland China are partially consistent with it. Complications, such as urethral fistula, false canal, ejaculation disorder, and penile curvature, decrease significantly.Conclusions: The main causes of urethral stricture in the recent 10 years are still trauma and iatrogenic injuries, and the etiology of urethral stricture is related to socioeconomic development. With the increase of intracavitary minimally invasive treatment and flap urethroplasty, the curative effect is increasing, while iatrogenic urethral stricture cannot be ignored.

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume® Drug-Coated Balloon for Anterior Urethral Strictures.

The Optilume® drug-coated balloon (DCB) is a urethral dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. The ROBUST III study is a randomized, single-blind trial evaluating the safety and efficacy of the Optilume DCB against endoscopic management of recurrent anterior urethral strictures. Eligible patients were adult males with anterior strictures ≤12Fr in diameter and ≤3 cm in length, at least 2 prior endoscopic treatments, International Prostate Symptom Score ≥11 and maximum flow rate <15 ml per second. A total of 127 subjects were enrolled at 22 sites. The primary study end point was anatomical success (≥14Fr by cystoscopy or calibration) at 6 months. Key secondary end points included freedom from repeat treatment, International Prostatic Symptom Score and peak flow rate. The primary safety end point included freedom from serious device- or procedure-related complications. Baseline characteristics were similar between groups, with subjects having an average of 3.6 prior treatments and average length of 1.7 cm. Anatomical success for Optilume DCB was significantly higher than control at 6 months (75% vs 27%, p <0.001). Freedom from repeat intervention was significantly higher in the Optilume DCB arm. Immediate symptom and urinary flow rate improvement was significant in both groups, with the benefit being more durable in the Optilume DCB group. The most frequent adverse events included urinary tract infection, post-procedural hematuria and dysuria. The results of this randomized controlled trial support that Optilume is safe and superior to standard direct vision internal urethrotomy/dilation for the treatment of recurrent anterior urethral strictures <3 cm in length. The Optilume DCB may serve as an important alternative for men who have had an unsuccessful direct vision internal urethrotomy/dilation but want to avoid or delay urethroplasty.