Treatment Of Urethral Strictures Research Articles

Urethroplasty technological changes for the treatment of male urethral stricture

Urethroplasty is an important method to treat male urethral stricture. Nowadays, urethroplasty mainly includes two types: anastomotic urethroplasty and substitution urethroplasty. Anastomotic urethroplasty mainly includes primary anastomosis urethroplasty and non-transecting anastomotic urethroplasty. Substitution of urethroplasty mainly includes staged urethroplasty and one-stage urethroplasty. Substitution materials always are chosen by pedicle skin flap and free mucosal graft. Anastomosis urethroplasty has shown good results in short bulbar urethral stricture and posterior urethral stricture after pelvic fracture. Among them, non-transecting anastomosis urethroplasty has become a new surgical method for iatrogenic, single, short or non-occluded stenosis. At present, the one-stage substitution urethroplasty is the most widely used. However, there are still many complicated cases that must be solved by staged urethroplasty. Pedicle skin flap and oral mucosa are widely used as substitutes at present. How to select the best surgical procedure and substitute materials individually would be the problem worthy of attention in the future. Accumulating more long-term follow-up data is helpful for objective comparison of various surgical procedures and grafts.

Functional Outcomes after Radiation Therapy or Radical Prostatectomy with Postoperative Radiation Therapy for High-Risk Prostate Cancer

<h3>Purpose/Objective(s)</h3> The use of radical prostatectomy (RP) for men with high-risk prostate cancer (PC) is increasing. RP is often utilized as a component of multi-modality therapy, as a method to intensify treatment. Many patients who undergo RP will subsequently require radiation therapy (RT), exposing patients to side effects from both treatments. While the side effects of RT and RP have been directly compared in previous studies, there is limited data comparing side effects of primary RT with those of patients undergoing RP and RT (RP/RT). We hypothesize that patients undergoing RP/RT for high-risk PC will experience significantly higher side effects than those undergoing primary RT. <h3>Materials/Methods</h3> We used the Surveillance Epidemiology and End Results (SEER) database with Medicare insurance claims to identify patients 66 years or older with primary high-risk PC who underwent RP, RT, or both between January 1, 2004 and December 31, 2013. High-risk PC was defined as disease meeting one or more of the following criteria: stage ≥ T3a, grade group ≥ 4, PSA >20. Outcomes of interest included treatment for urinary incontinence, urethral stricture, erectile dysfunction (ED), proctitis and cystitis at least 1 year after completion of primary prostate cancer treatment, which were captured using diagnosis and procedure codes. Rates of these endpoints were compared using cumulative incidence functions as well as cox proportional hazard models. Patients who were lost to follow up or died were censored at the time of their last encounter. <h3>Results</h3> The cohort included 17,649 patients, of which 15,399 were treated with primary RT (87.25%) and 2,250 were treated with RP/RT (12.75%). On multivariable analysis, compared to primary RT, RP/RT was associated with an increased risk of incontinence therapy [HR 1.907 (1.679-2.166)], stricture therapy [HR 1.865 (95% CI: 1.589-2.190)] and ED therapy [HR 2.869 (95% CI: 2.046-4.023)] after treatment for prostate cancer. Rates of therapy for cystitis or proctitis were not significantly different between these two groups. <h3>Conclusion</h3> For men with high-risk PC, treatment with RP/RT was associated with increased utilization of incontinence therapy, stricture therapy, and ED therapy after completion of prostate cancer treatment. With multiple curative treatment options and long duration of survival after treatment, the side effect profile of treatment is a major factor in determining the most appropriate course of treatment for an individual patient. Patients considering primary RP as a component of multimodality therapy for high-risk PC should be informed about the increased risk of side effects. Clinical trials are required to better evaluate this treatment paradigm.

The use of a modified tanagho flap in the repair of posterior urethral stricture after primary exstrophy closure

In patients with classic bladder exstrophy (CBE), posterior urethral strictures after primary bladder closure can be difficult to manage and therefore necessitate alternative techniques in reconstruction of the proximal urethra. There is a paucity of literature describing treatment and management of posterior urethral stricture arising after repair of classic bladder exstrophy. To describe the technique of a bladder neck reconstruction (BNR) with a modified Tanagho anterior detrusor flap in the treatment of posterior urethral stricture arising after repair of classic bladder exstrophy. A prospectively maintained, IRB-approved database of 1401 exstrophy-epispadias patients was reviewed for patients who underwent bladder neck or proximal urethral reconstruction with modified Tanagho flap for proximal urethral stricture disease from the time period of 1975-2021. A total of 5 patients (1 female and 4 males) with classic bladder exstrophy who underwent proximal urethral reconstruction with modified Tanagho flap were identified. Of these 5 patients, the 1 female patient was treated for ongoing incontinence, not posterior urethral stricture, and was thus excluded from this report. Outcomes measured included post operative bladder capacity, post-operative continence status, upper urinary tract status, and stricture recurrence. Four male patients with CBE were treated for posterior urethral strictures and are reviewed here. Three patients underwent successful primary closure (1 via modern staged repair of exstrophy (MSRE) and 2 via complete primary repair of exstrophy (CPRE)), and 1 patient (MSRE) required repeat closure at the time of stricture repair. Mean age at BNR Tanagho flap was 3.8 (range 2.3-5.0) years. All patients remained stricture free with post-operative urinary incontinence; 2 patients underwent subsequent elective bladder neck transection to achieve continence. Mean follow up 9.9 (range 2.1-15.6) years. All 4 patients had excellent long term success rates, comparable to results reported in several adult studies utilizing a modified Tanagho flap in women with post-traumatic bladder neck contractures. In addition, our technique described here shares similarities with both the originally described Tanagho flap as well as with a dorsal onlay graft urethroplasty. In this limited series, modified Tanagho flap reconstruction is effective in treating posterior urethral stricture disease in CBE. This technique adds a valuable adjunct to the armamentarium of surgical options for this difficult to manage condition.

Mesh Graft Urethroplasty-Still a Safe and Promising Technique in Mostly Unpromising Complex Urethral Strictures.

Long urethral strictures or even recurrent urethral strictures, mostly with scar tissue showing insufficient healing tendencies, are defined as complex and represent a big challenge in modern reconstructive urology. Initially, the treatment of complicated urethral strictures was associated with a high failure rate (20–40%) due to the growth of hair in the neourethra and a lack of sufficient suitable epithelium when scrotal skin was used. Although much effort was put into tissue engineering recently, harvesting and transplanting autologous tissue represent the standard of care for urethral substitution or augmentation. Since 1977, two-staged urethroplasty with the usage of free foreskin or 0.1 mm thick meshed skin from the upper leg was performed in complicated cases and was initially described in 1984 and 1989 by Schreiter and Schreiter and Noll, respectively. In stage 1, the graft is harvested by cutting the skin thinly above the hair follicles and transplanted as a plate around the opened urethra. In stage 2, after 8–12 weeks, the neourethra is formed. Success rates of up to 84% are described. Considering the complexity of the strictures in which mesh graft urethroplasty is usually performed, the reachable success rates are outstanding, especially considering that this surgery is most likely the last opportunity to prevent perineostomy or even urinary diversion. This article describes the surgical technique and embeds the mesh graft urethroplasty in today’s literature to underline its importance in the surgical management of complex urethral strictures.

Using the PROM-USS and IIEF Questionnaires in the Assessment of Lower Urinary Tract Symptoms, Quality of Life and Sexual Function in Patients with Urethral Stricture

Введение. С учетом распространенности стриктур уретры (СУ) у мужчин с частотой 229–627 случаев на 100 тысяч необходимость предоперационной диагностики будет иметь все возрастающий характер.Цель. Проанализировать степень выраженности симптомов нижних мочевых путей, качество жизни и уровень сексуальной функции у пациентов мужского пола со стриктурой уретры.Материалы и методы. Проспективное исследование включает группу из 100 пациентов, которыми во время стационарного лечения по поводу СУ производилось заполнение валидированных опросников PROM-USS и IIEF.Результаты. Медиана возраста пациентов, включенных в исследование, составила 56 лет. У 55 (55%) из опрошенных пациентов стриктуры носили рецидивный характер. Этиология в 25% случаев являлась идиопатической. Продемонстрировано наличие более низкого качества жизни у пациентов с установленной цистостомой. Большинство пациентов отмечали снижение по таким доменам, как подвижность, уход за собой, повседневная деятельность, а также наличие дискомфорта и депрессии. Выявлены показатели, характеризующие значимый уровень симптомов нижних мочевых путей. При оценке доменов опросника IIEF отмечено снижение уровня эректильной функции, удовлетворенности половым актом, либидо и оргазмической функции (p&lt;0,05).Заключение. Оценка параметров при использовании анкет PROM-USS и IIEF может быть полезным инструментом в определении показаний и выборе типа оперативного лечения СУ. Требуется дальнейшая послеоперационная оценка динамики по указанным параметрам в целях возможного выделения критериев, коррелирующих с факторами наступления рецидива. Introduction. Considering the prevalence of urethral strictures in men with a frequency of 229–627 cases per 100 000 males, the need for preoperative diagnosis will have an increasing role.Purpose. To analyze the severity of lower urinary tract symptoms, quality of life and level of sexual function in male patients with urethral stricture.Materials and methods. The prospective study included a group of 100 patients who filled the validated PROM-USS and IIEF questionnaires during inpatient treatment for urethral stricture.Results. The median age of patients included in the study was 56 years. In 55 (55%) of interviewed patients, strictures were recurrent. The etiology in 25% of cases was idiopathic. The presence of a lower quality of life in patients with cystostomy has been demonstrated. Most of the patients noted a decrease in such domains as mobility, self- care, daily activities, and noted the presence of discomfort and depression. There was revealed the presence of indicators characterizing a significant level of lower urinary tract symptoms. When assessing the domains of the IIEF questionnaire, a decrease in the level of erectile function, satisfaction with sexual intercourse, the level of libido and orgasmic function was noted (p&lt;0.05).Conclusion. Parameters evaluation using the PROM-USS and IIEF questionnaires can be a useful tool in determining indications and choosing the type of surgical treatment of urethral stricture. Further postoperative assessment of the dynamics of the indicated parameters is required in order to possibly identify those criteria that correlate with factors of recurrence.

V03 - Female urethroplasty for the treatment of urethral stricture, which surgical option to choose? About two cases: oral mucosal graft and vaginal mucosal flap

V03 - Female urethroplasty for the treatment of urethral stricture, which surgical option to choose? About two cases: oral mucosal graft and vaginal mucosal flap

Применение уретральных стентов при стриктурах уретры

Urethral stents have been popular in urology since the early 1980s and are used in the treatment of urethral stricture. The literature review presents data on the introduction into urological practice and the use of urethral stents in urethral strictures.

Comparative study between thulium laser and cold knife visual urethrotomy for treatment of short bulbomembranous urethral stricture.

Introduction:The classical way to treat urethral stricture is the direct vision cold knife internal urethrotomy (DVIU). Along with advances in laser technology, laser urethrotomy is widely used, such as neodymium-doped yttrium aluminum garnet, argon, potassium titanyl phosphate, and thulium laser. We aimed to compare thulium laser urethrotomy (TLU) and cold knife visual urethrotomy (CKVU) in terms of short bulbomembranous urethral stricture management.Materials and methods:This prospective interventional study was conducted for 24 months, from January 2018 to January 2020, on 60 patients with primary short bulbo-membranous urethral stricture who came to the Department of Urology of Al-Azhar University Hospital, New Damietta, Egypt. We divided these patients into 2 age-matched groups; 30 patients treated with CKVU and 30 patients with TLU.Results:Regarding efficacy, postvoid residual urine volume (PVR) was reduced significantly in both groups (P < .001) after 6 months of follow-up; however, the reduction in TLU was greater than CKVU (P = .008). The improvement of Qmax after 6 months was significant and comparable in both groups. Regarding the quality of life, both groups showed a significant (<0.05) improvement in international prostate symptom score (IPSS) and the Male Sexual Health Questionnaire (MSHQ) scale, without no significant difference between both groups (>0.05). TLU showed a significantly (P = .038) shorter operative duration (24 ± 4.17 min) than CKVU duration (33 ± 4.86 min). Compared with CKVU, TLU was associated with less blood loss during surgery (P = .001), lower recurrence rate (46.7% vs. 19.97%, respectively), and lower frequencies of urethral dilatation (P = .001).Conclusion:TLU is an effective and safe therapy for managing bulbomembranous urethral strictures, with a relatively low recurrence rate. Further investigations of other techniques are recommended to look for the most appropriate procedure to combat the urethral stricture problem.

Urethrotomy and End-to-End Urethroplasty in Anterior Urethral Strictures upto 1.5cm Dept of Urology Mayo Hospital, Lahore

Aim: To compare internal optical urethrotomy with end-to-end urethroplasty in treatment of anterior urethral stricture (&lt;1.5cm) in terms of recurrence. Study design: Cross-sectional Study. Place and duration of study: Mayo hospital, department of urology. June 2016 to July 2018 Methodology: Only 80 patients (40 individuals in each class) were included in the study with nonprobability convenience sampling. Urethral stricture of the same length was treated by class-A and class-B, but with different methods. 3 months after the initial diagnosis, the recurrence rate was examined. SPSS-22 was used to enter and analyse the data. Result: Patients' recurrences three months later indicated a significant difference (P=0.002) as a P value less than 0.05. A recurrence rate of 20% was found in class A end-to-end urethroplasty patients, whereas a stricture-free rate of 80% was found in the other 32. Stricture recurrence was seen in 52.5% of the patients in class B (internal optical urotomy), compared to 47.5% in class A. Conclusion: A urethroplasty is the best therapy for urethral strictures of 1.5 cm or more, according to this research. For the most part, the fundamental distinction between the two procedures is that urethroplasty has a lower rate of repeat surgeries than that of the other procedure. Keywords: Stricture urethra, Urethroplasty, Recurrence, Dilation, Urine obstruction,

Efficacy of urethral reconstruction for urethral stricture associated with hypospadias surgery in adults.

We report our experience with urethral reconstruction for hypospadias surgery-related urethral stricture in terms of surgical and patient-reported outcomes. Twenty-nine adult males who underwent urethral reconstruction for hypospadias surgery-related urethral stricture between August 2008 and January 2022 were retrospectively reviewed. Uroflowmetry and patient-reported outcomes were evaluated at 3, 6, and 12 months, and annually thereafter. Surgical success was defined as the absence of additional procedures. Patients were asked to rate their satisfaction with urethral reconstruction as "very satisfied", "satisfied", "unsatisfied", or "very unsatisfied". The median patient age at referral was 43 years. The median number of previously performed hypospadias surgeries was three, and 18 patients (62.8%) had been treated with repeated transurethral procedures. The median stricture length was 54 mm (interquartile range 36-81). Performed urethral reconstruction included staged urethroplasty in 22 (75.9%), one-stage onlay augmentation in 3 (10.2%), and perineal urethrostomy in 4 (13.8%) cases. Urethral reconstruction was successful in 26 patients (89.7%) over a median postoperative period of 31 months. Patient-reported outcomes were assessed in 25 (86.2%) patients. The mean maximum flow rate, international prostate symptom score total score, international prostate symptom score quality of life score, and EuroQol-5 dimensions index significantly improved postoperatively. Twenty-three patients (92%) were "very satisfied" or "satisfied" with the outcome of their urethral reconstruction. Urethral reconstruction is a highly successful and patient-satisfying treatment for hypospadias surgery-related urethral stricture in adult patients. Perineal urethrostomy is a reasonable alternative for elderly patients and for patients with complicated hypospadias surgery-related urethral strictures.

Management and outcomes of urethral stricture: single centre experience over 13 years.

To present a comprehensive summary of the diagnosis, treatment and follow-up process of patients who underwent open urethroplasty in our tertiary referral center for the treatment of urethral stricture in the last 13 years. Two hundred and forty-five (245) patients who underwent open urethroplasty between January 2008 and June 2021 were retrospectively analysed. Detailed history, physical examination, uroflowmetry, retrograde urethrography and/or voiding cystourethrography and/or urethroscopy were used throughout the preoperative diagnosis process. While evaluating the postoperative patency rates, the absence of preoperative voiding symptoms after the operation and Qmax 15 ml/sec and above were taken into account. Mean stricture length was 3.8 +/- 1.4 cm. Transurethral endoscopic interventions in 79 patients (32.2%), catheterisation in 55 patients (22.4%), trauma in 54 patients (22%), infection in 15 patients (6.2%), and idiopathology in 42 patients (17.2%) were the causes for the stricture. Buccal mucosal graft was used in 125 patients (51%), penile skin flap in 32 patients (13%), end-to-end anastomosis in 83 patients (33.8%) and Heineke-Mikulicz technique in 5 patients (2%). Mean follow-up period was 67.1 +/- 28.9 months. Success rates of patients were 84% (105) in buccal mucosal graft, 78.1% (25) in penile skin flap, 86.7% (72) with end-to-end anastomosis and 80% (4) with Heineke-Mikulicz technique. Among treatment options for urethral stricture, urethroplasty techniques is the most successful treatment. Consideration of the factors leading to the formation of the stricture, with the intraoperative findings and surgical experience will maximize the benefit the patient receives.

Non-transecting dorsal mucosal anastomosis plus ventral oral graft for the treatment of urethral bulbar strictures: single surgeon experience.

To report our experience with the non-transecting dorsal mucosal anastomosis plus ventral oral graft urethroplasty (NTAVOG) for the repair of tight bulbar urethral strictures. Data of 68 men with tight bulbar strictures underwent NTAVOG urethroplasty between 2012 and 2019 were retrospectively revised. The urethra was opened ventrally; the dorsal scarred mucosa was excised preserving the spongiosum; the mobilized mucosal edges were anastomosed to recreate the dorsal urethral plate; the repaired urethral plate was augmented by the ventral oral graft and the spongiosum was closed over it. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Sexual function was investigated using a validated questionnaire. Median follow-up was 58months (IQR 38-63) and mean stricture length was 1cm (IQR 1-1.5). Of 68 cases, 56 (82.4%) were successful and 12 (17.6%) were failures requiring re-treatment. At multivariable analysis, no preoperative factor was significantly associated with recurrence. None of the preoperatively sexually active 53 patients reported postoperative erectile impairment and all were satisfied with their sexual life. The main limitation is the retrospective design. In cases of tight bulbar stricture, the NTAVOG urethroplasty provides adequate urethral augmentation by preserving the spongiosum and avoiding postoperative sexual complications. We presented a series of patients undergone non-transecting dorsal anastomosis plus ventral oral graft urethroplasty for tight bulbar stricture. This treatment seems to be safe and with limited postoperative complications thanks to the preservation of the corpus spongiosum.

Comparison of Single versus Double BMG Urethroplasty in the Treatment of Bulbar Urethral Stricture

Background: Bulbar urethral strictures require comprehensive and careful urological management. Augmentation urethroplasty is the preferred treatment method and buccal mucosa has gained widespread popularity as the graft of choice for bulbar urethroplasty. Objective: To compare the outcomes of single versus double BMG urethroplasty in the treatment of bulbar urethral stricture. Methods: This prospective observational study was conducted in the Department of Urology, National Institute of Kidney Diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2018 to December 2019 over a period of one and half years. In this study, 22 patients had single BMG urethroplasty and 38 patients had double BMG urethroplasty. Qmax, dilation requirement, recurrent stricture and postoperative complications were recorded and compared. SPSS 12 was used for analysis. Categorical data were compared with Chi-square test and numerical data were compared with unpaired t test. Results: Maximum patients were more than 40 years old in both groups. Mean age was 40.77 ± 8.52 years &amp; 38.97 ± 10.07 years in single and double BMG group respectively (p&gt;0.05). Most of the patients were either overweight or obese in both groups (p&gt;0.05). In most of the cases aetiology of structure was unknown in both groups. Length of graft was 4.59 ± 0.65 cm and 4.43 ± 0.51 cm in single and double BMG group respectively. Peroperative Qmax was 8.00 ± 1.54 ml/sec and 7.61 ± 1.73 ml/sec in single and double BMG group respectively. Postoperative Qmax after 1 month and after 3 months was significantly higher in double BMG group than single BMG group (23.87 ± 1.79 ml/sec vs 21.73 ± 2.37 ml/sec and 20.71 ± 3.25 ml/sec vs 14.95 ± 1.29 ml/sec). Percent increment of Qmax after 3 months comparing pre-operative was significantly higher in double BMG urethroplasty group than that of single BMG urethroplasty group. Wound infection was higher in single BMG group than that of double BMG group but difference was not statistically significant (27.3% vs 13.2%; p=0.310). Recurrent of stricture was significantly higher in single BMG urethroplasty group than that of double BMG urethroplasty group (45.5% vs 21.1%; p=0.04 Conclusion Double BMG urethroplasty is better than single BMG urethroplasty in the treatment of bulbar urethral strictures. Bangladesh J. Urol. 2021; 24(1): 82-86

The treatment practices for anterior urethral strictures in China: A case-based survey.

ObjectiveTo investigate the treatment concept of Chinese urologists for anterior urethral strictures based on actual cases.MethodsA self-designed case-based questionnaire was distributed to the members of Official WeChat account of Learning Union from March 19, 2020, to April 10, 2020. Questionnaires requested respondents' demographic information and responses to five cases of anterior urethral stricture: short obliterative bulbar urethral stricture caused by straddle injury (Case 1), idiopathic bulbar urethral stricture after failure of multiple endoscopic therapy (Case 2), iatrogenic long penile urethral stricture (Case 3), lichen sclerosis-related urethral stricture (Case 4), and anterior urethral stricture in indwelling catheter after multiple failure of endoscopic surgery (Case 5). Data was described by frequency and percentage.ResultsA total of 1,267 valid anonymous questionnaires were received. Urethroplasty was recommended more frequently than endoscopic surgery (Case 1: 47.8% vs. 32.8%,Case 2: 42.5% vs. 33.8%, Case 3: 36.1% vs. 26.7%). Referrals patients to other urologists engaged in urethral repair and reconstruction account for a high portion of the treatment (Case 1:18.4%, Case 2:23.1%, Case 3:36.5%, Case 4:27.7%,Case 5:9.3%). Excision and primary anastomosis urethroplasty (EPA) was preferred for treatment of Case 1 (42.5%). For Case 2, the most popular choice was EPA (30.6%). Although the patient has a history of failure in endoscopic surgery, 33.8% of urologists continue to choose endoscopic surgery. For Case 3, 20.0% of urologists would perform oral mucosal urethroplasty. Surprisingly, 5.9% chose EPA. For Case 4, 37.3% of urologists selected meatotomy, 30.4% suggested that glans and urethral biopsies should be performed. 21.0% chose to use steroid ointment after surgery. For Case 5, 26.3% of the respondents believed that urethrography should be performed after removing catheter more than one week, if the urine is obstructed during the period, performing cystostomy firstly.ConclusionsIn China, the concept of urethroplasty is more widely accepted than endoscopic surgery for the treatment of anterior urethral strictures. The concept of referral has been widely formed among Chinese urologists. Better understanding of the comprehensive treatment of lichen sclerosis related anterior urethral stricture and the principle of urethral rest should be strengthened.

Treatment of patients with anterior urethral strictures: the role of perineal urethrostomy

The article reviews the 2000-2020 literature on the use of perineal urethrostomy in the treatment of patients with anterior urethral strictures. Historical issues of the development of urethrostomy techniques are considered. The algorithms to choose the method of treatment of urethral strictures in favor of perineal urethrostomy are highlighted, according to the guidelines of the world's professional urological associations. The performance indicators of perineal urethrostomy were studied considering the age characteristics of the patients, the etiological genesis of the strictures, their length and location, as well as depending on the surgical technique and the follow-up period. Considerable attention is paid to studies devoted to the analysis of the functional results of urethrostomy, as well as the quality of life of patients associated with urination and sexual activity. Data are presented on the incidence of early and late surgical complications, including urethrostomy stenosis, as one of the most common. An analysis of studies evaluating factors that negatively affect the outcome of surgery was carried out. The main reasons for the growing demand for the technique in surgery for complex anterior urethral strictures and the importance of the technique among other treatment methods are discussed.

Diagnosis and treatment of urethral stricture in men with neurogenic lower urinary tract dysfunction:A systematic review.

To summarize available data focused on diagnosis and management of urethral stricture in men with neurogenic lower urinary tract dysfunction by a systematic review of the literature. A systematic review of the literature was carried out through an extensive electronic database search performed in PubMed/MEDLINE and Scopus databases for full texts, and International Continence Society, American Urology Association, and European Association of Urology abstracts for citations related to urethral structure. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A total of 316 articles were identified, 48 of which were selected for this review. Different strategies are currently being used for the management of urethral strictures, such as clean intermittent catheterization (CIC)which reduces stricture by up to 68%; direct vision internal urethrotomy which shows lower rates of renarrowing; urethroplasty which shows a success rate up to 70%; urinary diversion is the treatment of choice when reconstruction is not possible. Further studies are needed in this population because of the heterogeneity of the outcomes and the lack of a standardized definition and classification of this population.

Dorsal Onlay Urethroplasty Using Buccal Mucosal Graft and Vaginal Wall Graft for Female Urethral Stricture; Outcome of a Tertiary Care Hospital

Background: Normally female urethral stricture (FUS) is uncommon and underdiagnosed condition. It is raising a diagnostic challenge for the physicians. It is the one of the rarely known urological entity. Urethral dilatation is the traditionally used treatment for urethral stricture (FUS). The female urethroplasty have shown the promising outcomes. Objective: The objective of the study was to compare the outcome of the dorsal onlay urethoplasty FU obtained by using buccal mucosal graft and vaginal wall graft. The FU is more effective treatment for female urethral stricture (FUS) as compared to the repeated dilatation. Study design: It is a retrospective study with the statistical approach, conducted at Urology Department, Pakistan Institute of Medical Sciences Islamabad from June 2021 to November 2021. Material and Methods: The women who underwent the dorsal onlay urethropasty at the urology department of the hospital were included in the study. The outcomes of BMG and VWG were compared. The re-intervention was marked as failure. The association symptom score, postvoid residual urine (PVR), cystourethrogram, cystoscopy and uretheral calibration were included in the assessment. Operating time, catheter time, etiology, location, length, prior interventions and suprapubic cystostomy were the other parameters that was also reported. For the statistical analysis the Mann-Whitney test, t-test and proportion test was performed. Results: The calculated mean age of the patients included in the group was 48 years. Its range was between the 26 to 76 years. The women visited the urology department of the hospital from June 2021 to June 2022. The average follow-up was for 26 months. The AUA symptoms changes from 22 to 6, Qmax from 4ml/s to 26ml/s and RVR from 185ml to 7ml. The operating time was the only parameter showed the difference, while other remained the same. The 94% was the overall urethral patency rate. Conclusion: For the substitution of dorsal onlay urethroplasty the use of VWG and BMG is highly recommended. It is an efficient and reliable treatment method. There are very low chances of complication and it has an easy protocol. Apparently, no specific change was observed in the FUS treatment by BMG and VWG. Keywords: Female urethral stricture (FUS), buccal mucosal graft, vaginal wall graft, postvoid residual urine (PVR), dorsal onlay urethroplasty.

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.