Treatment Of Urethral Stricture Disease Research Articles

Management of Urinary Symptoms after Urethroplasty

Abstract Purpose of review The most definitive treatment for urethral stricture disease is urethroplasty, a procedure that has demonstrated great efficacy and durability in creating a patent urethral lumen. Criteria for success after urethroplasty have evolved over time, now with growing recognition of the importance of the patient experience. Recent Findings Despite good surgical outcomes, patient reported metrics demonstrate that some patients have persistent urinary symptoms that impact satisfaction rates. Achieving success in patient reported outcomes after urethroplasty may require repeat intervention or addressing alternative etiologies including benign prostatic hypertrophy, overactive bladder, and underactive bladder. Summary For patients who do not achieve symptom resolution after urethroplasty, evaluation should include addressing common complications, evaluating for recurrence, and consideration and treatment of additional causes of urinary bother.

The Historical Origins and Contemporary Role of the Endoscopic Treatment for Urethral Stricture Disease

The Historical Origins and Contemporary Role of the Endoscopic Treatment for Urethral Stricture Disease

Efficacy of Jatyadi Taila Uttarbasti in the Management of Urethral Stricture a Single Case Study

In Ayurveda, Acharya Sushrut mentioned an excellent treatment named Uttarbasti for urethral stricture known as Mutrakruccha in classical scriptures. Mutrakruccha translates to difficulty in micturition. It can be associated with urethral stricture due to the similarity of symptoms. Urethral stricture disease is often seen in patients with recurrent urinary tract infections, urethral injuries, or post-surgical procedures conducted through the urethra. The most common causes of urethral stricture today are traumatic or iatrogenic. Inflammatory or infectious, malignant, and congenital aetiologies are less common. There is a low success rate of Western medical science treatment for urethral stricture disease. Surgical treatment of urethral stricture disease is indicated when the patient has severe voiding symptoms, bladder calculi, increased postvoid residual, urinary tract infection, or when conservative management fails. Urinary tract infections (UTIs) should be adequately treated before surgical intervention. In this case study, a 39-year-old male patient complained of suffering from symptoms like the strangury of urine, pain during micturition, the flow of urine is very poor, frequent micturition and occasionally burning micturition. After clinical examination and radiological testing, the patient was identified as having urethral stricture and treated with Jatyadi Taila Uttarbasti for 21 days at Shalyatantra OPD, Government Akhandanand Ayurved College and Hospital, Ahmedabad. After completion of treatment, the patient felt 75% relief in symptoms. So, we can conclude that non-invasive treatment such as Uttarbasti is highly advisable in patients having Urethral stricture.

Shwadamstradi Ghrita Uttarbasti the Ayurvedic Treatment of Urethral Stricture

In Ayurveda, Acharya Sushrut mentioned miraculous treatment for urethral stricture or mentioned as Mutrakruccha in Ayurvedic classical texts.Which briefly means difficulty in micturition. Mutrakruccha can be correlated withUrethral stricture due to the similarity between the symptoms. Many surgical and non-surgical treatments are available in modern medical science. Still, dueto thehigh recurrence and huge financial burden on the health system, Ayurvedic treatment Uttarbasti is showing promising results in the management of Urethral Stricture.Uttarbasti is the delivery of therapeutic oil or decoction via the urethra or vaginal channel.Urethral strictures can result from inflammatory, ischemic, or traumatic processes. These processes lead to scar tissue formation; scar tissue contracts and reduces the caliber of the urethral lumen, causing resistance to the flow of urine. Urethral strictures arise from various causes and can result in a range of manifestations, from an asymptomatic presentation to severe discomfort secondary to urinary retention. Retrograde urethrogram (RUG) is the main diagnostic tool to find urethral stricture and help find the length of the stricture. There is no modernmedical-science treatment for urethral stricture disease, however, urinary tract infections (UTIs) should be adequately treated before surgical intervention. Surgical treatment of urethral stricture disease is indicated when the patient has severe voiding symptoms, bladder calculi, increased postvoid residual, or urinary tract infection or when conservative management fails. Due to the high recurrence rate of surgical intervention in Urethral stricture non-invasive treatment such as Uttarbasti is always appreciated.

MP42-12 TISSUE AND PHARMACOKINETIC RESPONSE TO TREATMENT WITH A DRUG-COATED BALLOON IN A PORCINE URETER MODEL

You have accessJournal of UrologyCME1 Apr 2023MP42-12 TISSUE AND PHARMACOKINETIC RESPONSE TO TREATMENT WITH A DRUG-COATED BALLOON IN A PORCINE URETER MODEL Michael Borofsky, Casey Dauw, and Sean Elliott Michael BorofskyMichael Borofsky More articles by this author , Casey DauwCasey Dauw More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Paclitaxel Drug Coated Balloons (PDCBs) have proven efficacious in the treatment of urethral stricture disease. Application of PDCBs for ureteral strictures holds promise but safety and efficacy of their use have yet to be evaluated. This study was designed to gather data concerning; pharmacokinetics, histology, safety and healing potential for the ureter after ureteral dilation with a PDCB in a porcine model. METHODS: Ureteral dilation with PDCBs was performed on three anesthetized female pigs. In all cases one ureter was treated with PDCB dilation alone while the contralateral ureter was treated first with holmium laser endoureterotomy followed by PDCB dilation. Treatments were delivered in the proximal and distal ureter on each side using either an 8mm x 50 mm or 10 mm x 50 mm PDCB. Retrograde pyelograms (RPG) were performed to assess for extravasation after dilation. Ureteral stents were placed. Animals were terminated at 10, 28 and 45 days and gross necropsy was performed. Ureteroscopy with RPGs were also performed during the 28 & 45 day termination procedure. Paclitaxel concentration was quantified from plasma, urine, and tissues. Histology was also performed on treatment site and adjacent tissue. RESULTS: PDCB dilation according to study protocol was successful in each case. Contrast extravasation was seen at each laser endoureterotomy/PDCB sites and none of the PDCB alone sites. All three animals survived to their scheduled termination date. RPG performed at 28 & 45 days showed complete resolution of extravasation though panureteral dilatation was seen in each case presumably related to stenting. Ureteroscopic and gross necropsy confirmed complete healing of treatment sites. Histology at 28 & 45 days showed only minimal inflammation of the PDCB alone treatment sites and complete healing of the endoureterotomy sites with otherwise minimal inflammatory response (Figure 1). Paclitaxel remained detecA in urine and target tissue for up to 45 days with plasma levels being below level of quantification. CONCLUSIONS: PDCBs are capable of delivering paclitaxel to the upper urinary tract and do not appear to inhibit potential for healing despite significant ureteral injury among healthy female pigs. Further data is necessary prior to applying this technique to strictured ureters in human subject. Source of Funding: Urotronic © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e571 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Borofsky More articles by this author Casey Dauw More articles by this author Sean Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Urethral Cancer After Urethroplasty: A Case Report and Review of the Literature

ObjectiveTo review and report data on transformation to urethral carcinoma after urethroplasty for urethral stricture disease. Primary urethral carcinoma is a rare entity, and guidelines lack high quality data from which to cite. Urethroplasty is a highly effective treatment for urethral stricture disease, though in rare cases complications may include development of urethral carcinoma. MethodsA systematic PubMed search was performed to identify all articles describing patients with urethral carcinoma after urethroplasty. Data were collected on the following parameters: patient age and sex, indication for urethroplasty, presentation of cancer, imaging, pathology, presence of metastasis, intervention, and outcome. ResultsThe final cohort included fourteen patients, 13 from previously published cases and one from our institution. The median patient age at presentation was 60, most had endoscopic management prior to urethroplasty, and the majority presented with decreased urinary stream. All patients developed squamous cell carcinoma of the urethra. Patients underwent radical resection, lymph node dissection, chemotherapy, or radiotherapy, often in combination. A majority of patients had died at the time of case report. ConclusionDevelopment of urethral squamous cell carcinoma, particularly after urethroplasty, is a rarely encountered process. Patients and urologists must have a high index of suspicion and investigate symptoms such as fistula or lower urinary tract symptoms, even if these occur many months or even years after buccal mucosa graft . By compiling previously reported cases and adding an additional case to the literature, we hope that familiarity with this entity will lead to earlier recognition and diagnosis of disease.

Urethral strictures caused by lichen sclerosus: evaluation of patient quality of life after buccal urethroplasty

Introduction. In modern medical practice, when conducting clinical trials to assess the effectiveness of the treatment, it has long been recognized that the quality of life of a patient is a highly informative indicator of the assessment of health status. Buccal urethroplasty is one of the most effective methods of surgical treatment of urethral stricture disease in men with scleroatrophic lichen.Materials and methods. Twenty-five patients with urethral stricture caused by scleroatrophic lichen aged 17 to 80 years were examined. All patients underwent buccal urethroplasty. Patient quality of life was assessed 1, 6, and 12 months after buccal urethroplasty using the SF-36 Health Status Survey, the International Prostate Symptom Score (IPSS; Quality of Life — QoL) and urodynamic studies. In addition, a survey of patients was conducted on the subject of satisfaction with the results of the operation.Results. The results of the survey reliably indicate the high efficiency of buccal urethroplasty, reflected in the dynamics of physical indicators (62.5 ± 0.7 vs 71.7 ± 0.9 vs 95.5 ± 1.0 vs 97.2 ± 1.1; p < 0.05) and psychological (69.2 ± 1.1 vs 77.0 ± 0.7 vs 92.2 ± 0.8 vs 96.2 ± 1.0; p < 0.05) well-being according to the SF- 36, IPSS total score (32.1±3.4 vs 15.0±2.7 vs 7.3±2.9 vs 6.8±2.4; p < 0.05) and QoL index (5.5 ± 1.2 vs 3.8 ± 1.7 vs 1.6 ± 1.5 vs 1.4 ± 1.4, p < 0.05). The maximum urine flow rate increased to 19.5 ± 1.2 ml/s one month after surgery, to 23.7 ± 1.7 ml/s after six months, and to 25.8 ± 1.3 ml/s after 12 months, compared to preoperative values of 15.8 ± 1.2 ml/s (p < 0.05).Conclusion. Replacement of affected urethral tissues with scleroatrophic lichen with buccal flap helps restore adequate urination and improve patient quality of life.

Long-Term Experience with Balloon Dilation for Short Bulbar and Membranous Urethral Strictures: Establishing a Baseline in the Active Drug Treatment Era.

Transurethral balloon dilation (BD) is a minimally invasive treatment for urethral stricture disease (USD) performed primarily or as a recurrence salvage maneuver. With the introduction of drug-coated balloons, we sought to characterize patient outcomes using non-medicated balloons. A retrospective review identified patients who underwent BD from 2007 to 2021. Patient and stricture characteristics were collected. All dilations employed the 24Fr UroMaxTM system. Clinical failure was defined by patient-reported lower urinary tract symptom recurrence or need for further stricture management. Ninety-one patients underwent BD with follow-up median (IQR) 12 (3–40) months. Most (75/91, 82%) had prior treatment for USD (endoscopic 50/91 (55%), 51/91 (56%) urethroplasty) before BD. Recurrence rates did not significantly differ between treatment-naïve and salvage patients (44% vs. 52% (p = 0.55)). Median (IQR) time to failure was 6 (3–13) months. The most common complications were urinary tract infection (8%) and post-operative urinary retention requiring catheterization (3%). Radiation history was noted in 33/91 (36%) with 45% recurrence. Patients without previous radiation had a similar recurrence rate of 52% (p = 0.88). Balloon dilation had minimal complications and overall, 50% recurrence rate, consistent regardless of stricture characteristics, radiation history, or prior treatments. These results represent an important clinical benchmark for comparing outcomes using drug-coated balloons.

PD31-07 DOES ORAL HEALTH AND GRAFT HISTOLOGY PREDICT POSTOPERATIVE OUTCOMES FOLLOWING ORAL GRAFT URETHROPLASTY?

You have accessJournal of UrologyCME1 May 2022PD31-07 DOES ORAL HEALTH AND GRAFT HISTOLOGY PREDICT POSTOPERATIVE OUTCOMES FOLLOWING ORAL GRAFT URETHROPLASTY? Jane Kurtzman, Preston Kerr, Rashed Kosber, Carlos Pagan, Mahveesh Chowdhury, and Steven Brandes Jane KurtzmanJane Kurtzman More articles by this author , Preston KerrPreston Kerr More articles by this author , Rashed KosberRashed Kosber More articles by this author , Carlos PaganCarlos Pagan More articles by this author , Mahveesh ChowdhuryMahveesh Chowdhury More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002582.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preoperative oral health is rarely considered when deciding treatment for urethral stricture disease. However, our previous pilot study of 51 patients and 37 grafts, demonstrated that preoperative oral health impacts oral graft (OG) histology and therefore, may affect urethroplasty success (J Urol., Sept 2021). We aimed to evaluate if oral health and OG histology impacts the risk of stricture recurrence following OG urethroplasty. METHODS: All patients who underwent OG urethroplasty from July 2018-Sept 2021 with completed preoperative oral health surveys: patient-completed Oral Health Impact Profile (OHIP14) and provider-completed Kayser-Jones Brief Oral Health Status Examination (BOHSE), were included. A staff pathologist analyzed OG histology and quantified oral mucositis (OM). Stricture recurrence was defined as a need for a second operative intervention for stenosis. Kaplan Meier (KM) curves and Cox proportional hazard ratios assessed the impact of OG histology and preoperative oral health on recurrence risk within 2 years of surgery. RESULTS: 89 patients (mean age: 47.9 years) and 111 harvested grafts were included. 70 grafts were reviewed in pathology. 51% had non-zero BOHSE (45/89) and 25% had non-zero OHIP14 (21/83) scores. Mean follow-up time was 13.1 months. 13% of patients recurred within 2 years. On age-adjusted analysis, increasing BOHSE and OHIP14 were associated with decreasing epithelial thickness (p=0.01 and p=0.03) and increasing OM score (p=0.01 and p=0.045). Increasing BOHSE also correlated with increased graft stretch (p=0.02). 18% of patients with non-zero BOHSE scores (8/45) recurred within 2 years, compared to 7% with zero BOHSE scores (3/44). Stricture recurrence free survival was not statistically different between these groups (HR 2.8, p=0.13; Figure 1). Cox proportional analysis also did not identify BOHSE (continuous), epithelial thickness, delta stretch or OM score, as risk factors for recurrence (all p>0.05). CONCLUSIONS: We re-demonstrated with a larger cohort, that preoperative oral health is associated with changes in OG histology and graft stretch. There appears to be a trend towards a relationship between worse oral health, measured by BOHSE, and risk of urethroplasty failure, however more patients and longer follow-up are likely needed to reach significance. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e543 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Preston Kerr More articles by this author Rashed Kosber More articles by this author Carlos Pagan More articles by this author Mahveesh Chowdhury More articles by this author Steven Brandes More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effects of Combination of Bi-inject (Triamcinolone and Mitomycin) After Direct Vision Internal Urethrotomy for Short Urethral Strictures

Background: Urethral stricture disease has always been a challenge for urologists. Different treatment modalities that are used for treatment of urethral stricture disease, however recurrence has been a persistent problem. Agents such as triamcinolone and mitomycin-C offer hope but merit to be researched.
 Objective: To test the combination of triamcinolone and mitomycin in direct vision internal urethrotomy (DVIU).
 Methods: This quasi-experimental analysis was conducted in Ziauddin Hospital North Nazimabad upon a sample of 116 patients (selected using non-probability, consecutive sampling) in two groups (A: Experimental and B: Control) of 58 each. Data was recorded onto a structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, disease history, operative notes and post0operative follow-up. The data obtained was analyzed using SPSS 21.0 and MS. Excel 365.
 Results: The mean age of the sample stood at 47 (SD ± 05) years, with the age ranging from 19 to 80 years. The etiology was idiopathic in most (55.2%) of the cases and the primary urethral strictures were the commonest (67.2%). Most strictures appeared between 6 to 9 months after the procedure and the incidence decreased with passage of time till no new cases were reported at 1 year. The outcome of the treatment in group A bi-inject given was regarded as success in 49 (84.5%) and in group B bi-inject not given was 32 (55.2%) of the cases. Among those that experienced a recurrence, majority (63%) of the patients experienced bulbar urethral stricture, while the remaining (37%) faced membranous urethral strictures. Few complications were seen in both groups, predominant among which was bleeding.
 Conclusion: After careful consideration, it is concluded administration of triamcinolone and mitomycin in direct vision internal urethrotomy (DVIU) yields a successful outcome significantly (<0.05) more frequently (84.5%) than the control group (52.5%).

Urethroplasty in Children: Experience at Tertiary Care Hospital, Peshawar, Pakistan

Objectives: The aim of this study is to share single center experience of urethroplasty in pediatric age group. Material and Methods: All boys of age less than 14 years who underwent urethroplasty at institute of kidney diseases from July 2017 to December 2020 are included in this study. The details received from hospital record system on a structured proforma and analysis was performed with SPSS version 20. Results: Total 75 pediatric patients with mean age of 8 ± 3.2 years are included. The main etiology identified was trauma (57.3%) followed by iatrogenic (30.7%), unknown/ idiopathic (8%) and post inflammatory (4%) causes. The commonest site of urethral stricture was bulbar (62.7%), which resulted in the majority of cases from trauma. Other sites were penile in 21% and posterior urethral in 16%. The end to end urethroplasty was the leading surgical procedure (85.3%) in these patients, penile skin flap and two stage urethroplasties were performed in 9.3% and 5.3% patients respectively. Urethroplasty was found highly successful (93.3%) in the treatment of urethral stricture disease. Conclusion: Children with history of perinial trauma and urethral instrumentation needs proper evaluation for lower urinary tract symptoms, as there is high suspicion of urethral stricture disease. Urethroplasty as the treatment of urethral stricture disease when performed in the specialized center is very effective modality of treatment.

Surgical treatment of urethral stricture disease - the earlier, the better.

Surgical treatment of urethral strictures is a constantly evolving process. There are various treatment options like internal urethrotomy (IUT) and open surgery. A variety of techniques for urethral reconstruction are available (grafts, flaps, and excision-reanastomosis). Functional results of urethral reconstructive surgery are very satisfying and with low rate of complications. We assessed the early open surgical reconstruction in comparison with the continuation with the endourological treatment - IUTs. The study included 129 patients with urethral strictures referred to our center. At that time point, they had received two unsuccessful IUTs and were divided into two groups - consecutive IUT and surgical repair, which included excision and reanastomosis or augmented urethroplasty. These patients were evaluated at 12 months using urethrography and uroflowmetry. Sexual function was evaluated using the international index of erectile function questionnaire 5-IIEF. Chi-squared test for statistical analysis was used. Successful outcomes (urethrography presented equal caliber and Qmax was >15 ml/sec 12 months after the procedure) were achieved in 59 (88%) of the patients using reconstructive surgery versus 26 (41.9%) of the patients with consecutive IUT (p<0.001). Mild sexual dysfunction was reported by 12 (17.9%) patients from the group with open surgery and 7 (11.3%) from the group with continuous IUT (p=0.289). Early open surgery seems a reasonable solution to the problem of urethral strictures as there are only a few complications from this surgery and the functional results are satisfactory. The success rate using open surgery was found to be significantly greater than that in the consecutive IUT group, whereas no differences in the complication rates regarding sexual function were observed.

Evaluation of the Extent of Primary Buccal Mucosal Graft Contracture in Augmentation Urethroplasty for Stricture Urethra: A Prospective Observational Study at a Tertiary Healthcare Centre.

Introduction Buccal mucosal graft (BMG) urethroplasty is considered as gold standard in the treatment of urethral stricture disease. The successful outcome after BMG urethroplasty varies between 66 and 99%. One of the possible causes for failure is BMG contracture. Primary BMG contracture rate is poorly understood and unreported. The present study aimed to evaluate the extent of contracture of buccal mucosa immediately after harvesting. Materials and Methods This was a prospective observational study conducted in the Department of Urology at our institute between January 2016 and December 2019. All patients with urethral stricture disease undergoing BMG urethroplasty for the first time were enrolled in the study after obtaining informed consent. Demographic and patient clinical profile was noted. Based on the intraoperative urethral stricture size, the preharvest graft was marked on the buccal mucosa and the size was calculated. Postharvest unstretched size of the graft was measured immediately after graft removal from the oral cavity. Alteration in BMG size was analysed using paired t-test. Results Forty-four patients were included in the study. Mean age of the patient was 53.6 years. Mean stricture length was 7.45 cm (range 4–12 cm). Mean pre- and postharvest BMG size was 8.3 × 1.5 cm and 7.6 × 1.3 cm, respectively. There was a 8.4% decrease in length and 9.5% decrease in width of the buccal mucosal graft. Conclusion Primary buccal mucosal graft contracture is around 8.4% in length and 9.5% in width. It would be better to mark wider than necessary while harvesting buccal mucosa so that tension-free anastomosis is performed.

Treatment of Urethral Stricture Disease in Women: Nonsystematic Review of Surgical Techniques and Intraoperative Considerations.

Female urethral strictures are rare, but underdiagnosed pathologies that can cause voiding dysfunction. These strictures are best managed with open reconstruction, as endoscopic treatments have high rates of failure. A flap urethroplasty can be performed with vaginal, labial or bladder tissue. Meanwhile, graft urethroplasties can utilize vaginal, labial, buccal or lingual tissue. It is important to consider the etiology and type of stricture, local vascularity, and prior attempts at repair when selecting the type of repair. Multiple different techniques have been described with theoretical advantages to each one. While some studies have reviewed a few of the reconstructive techniques to treat female urethral strictures, no single study has accounted for each individual technique. In this review, we discuss techniques captured by a number of systematic reviews and other articles. We will herein focus on reviewing and describing each unique technique of reconstruction in the setting of female urethral stricture.

Results of surgical treatment on short-length bulbous urethral strictures

Introduction. Urethral stricture disease is one of the most actual problems of modern urology, and the number of this pathology in the population increases year to year. To date, a large number of surgical methods for treating urethral strictures have been proposed. This study represents our experience in the surgical treatment of short-length bulbous urethral strictures. Purpose of the study. To analyze the results of surgical treatment of patients with short-length bulbous urethral strictures. Materials and methods. A retrospective analysis of the surgical treatment results in 75 patients with short-length bulbous urethral strictures was carried out. Treatment was carried out using various techniques: internal optical urethrotomy (IOUT), anastomotic urethral plasty, urethral plasty without crossing the spongy body. The effectiveness of the applied methods is assessed. The standard questionnaire I-PSS (International Prostate Symptom Score) was used to assess the quality of life of patients in all cases, which was filled out before surgery and 6 months after surgery. Results. The easiest and fastest to perform is the IOUT technique, but it has a high percentage of relapses — up to 76,47% in a follow-up. However, the number of recurrences when performing open surgical techniques, such as urethral plastic surgery without crossing the spongy body, anastomotic urethral plastic surgery, did not exceed 7.14% and 7.4%, respectively. Before surgery average IPSS score in patients who were carried out of IUOT, anastomotic plastic and plastic without crossing a spongy body, respectively 20,65 ± 0,62, 21,52 ± 0,64 and of 23,07 ± 0,76 points, and 6 months after surgical treatment the average score was 8,24 ± 0,63, 4,37 ± 0,33, 5,64 ± 0,37 points. Conclusions. It was revealed that currently, the most prognostically favourable methods of surgical treatment of urethral stricture disease are anastomotic urethral plasty, urethral plasty without crossing the spongy body.

Treatment of urethral stricture disease in women: A multi-institutional collaborative project from the SUFU research network.

Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR,3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.

Frequency of Extravasation on Pericatheter Retrograde Urethrogram in Patients Who Undergo Posterior Urethroplasty.

IntroductionUrethroplasty is the gold standard treatment for urethral stricture disease resulting from pelvic fractures, urethral manipulation, and straddle injuries. Post-operative morbidity depends on the presence of urethral catheterization with or without a suprapubic catheter (SPC). Urethral healing at the anastomotic site can be easily assessed using retrograde pericatheter urethrography (RPU). Post-operative removal of the catheter is traditionally performed on the 21st day following urethroplasty. However, some controversy still exists regarding the best feasible time of proper urethral healing and its assessment utilizing simple techniques. The duration of anastomotic healing differs depending on the type of procedure performed, but whether there is any significant difference in duration of healing at the anastomotic site according to the etiology of short‐segment stricture urethra is still a dilemma.Materials and methodsThis was a descriptive case-series conducted for a duration of six months from September 2019 to February 2020 at the urology department of a tertiary care hospital in Karachi, Pakistan. A sample population of 135 patients aged 20-50 years with posterior urethral stricture who underwent posterior urethroplasty with disease duration of >12 months was included in the study. All patients were put on the next operation theater (OT) list for urethroplasty. After surgery, the patients were catheterized and were kept in the ward under observation for 48 hours and discharged on the 2nd post-operative day. All patients were followed weekly and RPU was performed on the 21st day following urethroplasty to assess the presence of extravasation and the collected data was entered into the proforma by the investigators. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0.ResultsThe mean age of our participants was 32.8±6.02 years. The mean duration of the procedure was 26.3±7.14 months. Extravasation cases were observed in less than one-fifth (n=22 out of 135, 16.3%) of the posterior urethral stricture patients in our study.ConclusionsIt is to be concluded that extravasation is fairly common in patients who undergo posterior urethroplasty. The prevalence varies depending on the assessment method, likely reflecting the treatment of somatic symptoms.

Significant Management Variability of Urethral stricture Disease in United States: Data from the AUA Quality (AQUA) Registry

ObjectiveTo determine the degree of contemporary practice variation for the treatment of urethral stricture disease (USD) given repeated endoscopic management yields poor long-term success. Materials and MethodsThe AUA Quality (AQUA) Registry collects data from participating urologists across practice settings by direct interface with local electronic health record systems. We identified procedures used for USD using Current Procedural Terminology (CPT) and International Statistical Classification of Diseases (ICD-9/-10) codes. We assessed the association between patient and provider factors and repeated endoscopic treatment using generalized linear models. Provider details were derived from AUA Census. ResultsWe identified 20,640 male patients with USD treated surgically in AQUA from 2014-2018. The patients were cared for by 1343 providers at 171 practices, 95% of these community-based. Among patients with USD who had treatment, 20,101(97.9%) underwent endoscopic management. 6218(31%) underwent repeated endoscopic treatment during the study period. Urethroplasty was performed in 539(2.6%) patients. Median patient age at first procedure for endoscopic surgery vs. urethroplasty was 73 vs. 39 years old, respectively (p<0.001). At the practice level, significant variation in rates of repeated endoscopic management was noted. Patients of older age (OR=1.08, 95%CI: 1.06-1.11 for ages ≥80) and patients with a bladder cancer diagnosis (OR=1.17, 95%CI: 1.15-1.20) had higher odds of receiving repeated endoscopic management. Increasing practitioner age was also associated with increased odds of repeated endoscopic management. (OR=1.13, 95%CI: 1.11- 1.16, for practitioners ≥64). ConclusionsRepeated endoscopic management for USD is overused. The utilization of endoscopic management is variable across practices and frequently guideline-discordant, presenting an opportunity for quality improvement.

A drug-coated balloon treatment for urethral stricture disease: Two-year results from the ROBUST I study.

Mechanical balloon dilation and direct visualization internal urethrotomy (DVIU) are the most widely used treatments for urethral stricture disease in the U.S., but recurrence rates are high, especially after re-treatment. This study investigates the safety and efficacy of the Optilume™ paclitaxel-coated balloon for the treatment of recurrent strictures. Men with recurrent bulbar strictures ≤2 cm with 1-4 prior endoscopic treatments were treated with the Optilume™ drug-coated balloon. Patients were evaluated within 14 days, three, six, 12, and 24 months post-treatment. The primary safety endpoint was serious urinary adverse events. The primary efficacy endpoint was ≥50% improvement in International Prostate Symptom Score (IPSS) at 24 months. Secondary outcomes included quality of life, erectile function, flow rate, and post-void residual urine volume. A total of 53 subjects were enrolled and treated; 46 completed the 24-month followup. Forty-three percent of men had undergone >1 previous dilations, with a mean of 1.7 prior dilations. There were no serious adverse events related to treatment at two years. Success was achieved in 32/46 (70%), and baseline IPSS improved from a mean of 25.2 to 6.9 at 24 months (p<0.0001). Quality of life, flow rate, and post-void residual urine volumes improved significantly from baseline. There was no impact on erectile function. Two-year data indicates the Optilume™ paclitaxel-coated balloon is safe for the treatment of recurrent bulbar urethral strictures. Early efficacy results are encouraging and support further followup of these men through five years, as well as further investigation with a randomized trial.

Recent Advances in treatment of urethral stricture disease in men.

Urethral stricturing is a narrowing of the urethral lumen as a result of ischaemic spongiofibrosis. The main challenge of currently available treatment options is recurrence of the stricture. Recent advancements in the treatment of urethral strictures mainly came from the fields of regenerative medicine and tissue engineering. Research efforts have primarily focused on decreasing the recurrence of stricture after internal urethrotomy and constructing tissue-engineered urethral substitutes to improve clinical outcomes of urethroplasty surgeries. The aim of this article is to review the most recent advancements in the management of urethral stricture disease in men.