Two-stage Urethroplasty Research Articles

Single-Stage Versus Two-Stage Urethroplasty for Hypospadias

Single-Stage Versus Two-Stage Urethroplasty for Hypospadias

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

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

V08-10 ENDOSCOPIC URETHROPLASTY FOR MANAGEMENT OF MALE MEMBRANOUS URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023V08-10 ENDOSCOPIC URETHROPLASTY FOR MANAGEMENT OF MALE MEMBRANOUS URETHRAL STRICTURE Garrett Ungerer, Jayson Kemble, and Jonathan Warner Garrett UngererGarrett Ungerer More articles by this author , Jayson KembleJayson Kemble More articles by this author , and Jonathan WarnerJonathan Warner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture disease remains a challenging urologic problem, often requiring open repair using grafts or tissue flaps. While endoscopic management offers advantages including minimizing additional surgical trauma to the already scarred urethra and pelvic floor, urethral dilation and/or urethrotomy have been shown to have less durable outcomes compared to other urethroplasty techniques (end-to-end, graft, flap, or two-stage urethroplasty). In this video, we demonstrate a minimally invasive endoscopic approach to urethroplasty using buccal grafting for management of male membranous urethral stricture disease. METHODS: The procedure was performed for management of an 8mm flow limiting stricture within the membranous urethra in a male patient with prior history of prostate cancer managed by radiation who subsequently developed an 8mm flow limiting membranous stricture. The patient is prepped in dorsal lithotomy position. Under direct visualization via cystoscopy, the stricture is first balloon dilated. Next, a posterior strip of the superficial mucosa is resected from the bladder neck to just distal to the area of stricture, creating a 1cm wide bed for the graft to lay. After the defect is measured, a buccal mucosa graft is harvested in standard fashion. Two sutures are placed through the distal corners of the graft with the graft still outside the urethra, and the proximal end of the graft is then secured to the bladder neck using the RD 180 endoscopic suturing device. The proximal suture is cinched tight, pulling the graft to the bladder neck, and the distal end of the graft is pulled tight and flat along the defect using the two sutures attached to the distal graft. The graft is anchored to the posterior urethra using endoscopic Secure Straps. Once the graft is secure, a wire is passed into the bladder under direct visualization and a catheter is passed over wire to hold the graft flat during the subsequent 4 weeks. RESULTS: The procedure lasted 2.5 hours without any complications. Estimated blood loss was 50cc. Following the procedure, the patient was discharged home with a catheter in place. Catheter was removed at 4 weeks. At 10 weeks post-op, cystoscopy showed good graft viability, and peak flow was 20 ml/sec compared to 4 ml/sec pre-operatively. At six months, he continues to do well without evidence of recurrent urethral stricture. CONCLUSIONS: Endoscopic urethroplasty using buccal graft appears to offer a safe and effective repair option that could be considered for management of ureteral strictures. Source of Funding: none to report © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e751 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Garrett Ungerer More articles by this author Jayson Kemble More articles by this author Jonathan Warner More articles by this author Expand All Advertisement PDF downloadLoading ...

HF01-05 UKRAINIAN CONTRIBUTIONS TO UROLOGY: AN IMPORTANT REMINDER

You have accessJournal of UrologyCME1 Apr 2023HF01-05 UKRAINIAN CONTRIBUTIONS TO UROLOGY: AN IMPORTANT REMINDER Daniel Nemirovsky, Maksym Pikul, Zoe Blake, Alexander Kenigsberg, Neil Mendrihatta, Peter Pinto, and Gennady Bratslavsky Daniel NemirovskyDaniel Nemirovsky More articles by this author , Maksym PikulMaksym Pikul More articles by this author , Zoe BlakeZoe Blake More articles by this author , Alexander KenigsbergAlexander Kenigsberg More articles by this author , Neil MendrihattaNeil Mendrihatta More articles by this author , Peter PintoPeter Pinto More articles by this author , and Gennady BratslavskyGennady Bratslavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003243.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Over the past year, the world has witnessed acts of unprovoked violence and aggression in Ukraine. The AUA issued a strong statement standing against the atrocities and inhumanity of war. Many urologists, both with and without ties to Ukraine, have shown support to the country in various ways. In this light, it is imperative to not only support its citizens, but also to remember the contributions Ukraine has had on our understanding of urology. METHODS: Data was obtained with review of both PubMed and non-PubMed indexed literature, as well as through personal interviews with leading urologists in Ukraine. RESULTS: In the field of genitourinary reconstruction, the first ever use of oral mucosa in urethroplasty was pioneered by Kirill Sapezhko in the late 19th century, while working in Kyiv. Interestingly, Dr. Sapezhko was also the first recorded surgeon to describe a two-stage urethroplasty, using a method now known as the Thiersch-Duplay technique. Ludwik Rydygier, as head of the University of Lviv (then Lemberg), developed an early method for transperineal simple prostatectomy, as well as innovating several techniques for repair of vesicovaginal fistulae in the late 1800s. Yurii Voronoy, while working in Kherson during the early 20th century, revolutionized transplantation by conducting the first recorded renal allotransplant, as well as studying the various stages of immunologic rejection. In the mid-to-late 1900s, urologic oncologists in Kharkiv, including Boris Polonsky, Alexey Pereverzev, and Viktor Karpenko, conducted valuable research describing innovative techniques for IVC thrombectomy. More recently, Ukrainian scientists have made enormous strides in our understanding of urologic carcinogenesis, in large part due to the devastating Chernobyl disaster and related chronic ionizing radiation exposure. These studies have led to better insight into the development of kidney and bladder cancers, including the description of ionizing-radiation induced carcinoma in situ, termed “Chernobyl Cystitis”. CONCLUSIONS: Ukrainian urologists have made significant impacts to the field, with important and novel studies spanning across many urologic subspecialties. As urologists, one of the ways that we can support Ukraine is to highlight their many contributions to the field. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e257 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Nemirovsky More articles by this author Maksym Pikul More articles by this author Zoe Blake More articles by this author Alexander Kenigsberg More articles by this author Neil Mendrihatta More articles by this author Peter Pinto More articles by this author Gennady Bratslavsky More articles by this author Expand All Advertisement PDF downloadLoading ...

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.

The effect of staged TIP urethroplasty on proximal hypospadias with severe chordee

BackgroundProximal hypospadias with severe chordee is still a formidable challenge for most pediatric urologists, and the treatment approach remains controversial. Here, we describe a modified two-stage technique to repair proximal hypospadias with severe chordee.MethodsWe retrospectively identified 53 children referred for proximal hypospadias with severe chordee from July 2016 to July 2019, who underwent a two-stage urethroplasty. In group 1, the children were repaired with staged tubularized incised plate (TIP) urethroplasty, while Byars’ two-stage urethroplasty was attempted in group 2. We corrected chordee by releasing all remaining attachments to the corpora after degloving the penis, transceting the urethral plate, and dorsal plication. The mean age of patients in the first stage of surgery was 26.6 months in group 1 and 24.8 months in group 2. Postoperative complications in the two groups included: fistula, urethral stricture, urethral diverticulum, and glanular dehiscence.ResultsA total of 20 cases were repaired with staged TIP urethroplasty (group 1), and 33 cases were repaired with Byars’ two-stage urethroplasty (group 2). The length of follow-up in group 1 was 39.8 ± 10.1 months, and in group 2, it was 38.1 ± 8.7 months (P > 0.05). After the second stage of surgery, 1 case (5%) in group 1 and 11 cases (33.3%) in group 2 developed a urinary fistula (P < 0.05). One case (5%) in group 1 and three cases (9.1%) in group 2 had urethral stricture (P > 0.05). All strictures were cured by repeated dilation, and no patient required reoperation. No cases in group 1 and one case (3%) in group 2 had urethral diverticulum (P > 0.05). There was no residual chordee in both groups. Two cases (10%) in group 1 and 13 cases (39.3%) in group 2 required reoperation (P < 0.05).ConclusionsStaged urethroplasty is appropriate to repair proximal hypospadias with severe chordee. Particularly, staged TIP urethroplasty is a good choice for patients with proximal hypospadias and severe chordee, especially those with better penile development, wider urethral plate, larger glans, and deeper navicular fossa of the urethra.

Urethral strictures in boys after hypospadias treatment: two-staged buccal urethroplasty

Introduction. The most common cause of urethral strictures in boys is a complication of hypospadias treatment. Extended and complicated strictures represent the most difficult segment of the problem and the choice of the method of surgical correction.The study objective is to review the technique and results of replacement urethroplasty with buccal graft in urethral strictures that occurred after treatment of hypospadias in childhood.Materials and methods. A retrospective study conducted at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma from 2017 to 2020. Cases of 34 patients who underwent staged replacement buccal urethroplasty for complicated urethral stricture were studied. The examination revealed complications such as: Lichen sclerosus, short urethra, fistulas, diverticula, multiple (double) and extended strictures.Results. Complications occurred in 3 (8.8 %) patients: cutaneous urethral fistula developed in two, partial scarring of the free graft occurred in one child. Long-term results were assessed after an average of 16 months. Our experience of treating 34 pediatric and adolescent patients with p after-hypospadias strictures showed that the leading cause of stricture formation after hypospadias treatment is Lichen sclerosus, which occurred in 16 patients.Conclusion. During the last century, many donor tissues have been proposed for free urethroplasty, but it is the buccal graft that has won the largest number of supporters, and two-staged urethroplasty has become the method of choice for strictures of the anterior urethra. The surgeon’s considerable experience in performing buccal urethroplasty, adherence to the nuances of the technique and methodology of postoperative management, both at the first and second stages, allows you to obtain a good cosmetic and functional result even after a number of unsuccessful operations.

Commentary on the article “Comparative analysis of the use of one-stage and two-stage urethroplasty in the treatment of children with proximal forms of hypospadias. Flap or graft?”

Commentary on the article Surov R.V., Kagantsov I.M., Shmyrov O.S., Sizonov V.V., Volkova A.A., Zadykyan R.S., Kulaev A.V., Lasishvili M.N., Velskaya Yu.I. Comparative analysis of the use of one-stage and two-stage urethroplasty in the treatment of children with proximal forms of hypospadias. Flap or graft?, published in the Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(4):437444. (In Russ.) DOI: https://doi.org/10.17816/psaic968

FACTORS ASSOCIATED WITH URETHROCUTANEOUS FISTULA COMPLICATION IN HYPOSPADIAS PATIENT AFTER URETHROPLASTY IN FATMAWATI GENERAL HOSPITAL: A RETROSPECTIVE COHORT DESIGN

Objective: This study compared several factors that are thought to contribute to the incidence of complications of urethroplasty fistula after urethroplasty, including meatus location, degree of chordee, surgical technique, and postoperative stent type. Material &amp; Methods: This study is an analytical study with retrospective cohort design. After adjusting to the inclusion and exclusion criteria, 89 subjects with proximal hypospadias were subjected to urethroplasty at Fatmawati General Hospital, Jakarta from 2016 to 2019. An analysis of the relationship between several variables and the incidence of uretrocutaneous fistula was analyzed. Results: There was no significant difference between the one-stage and two-stage urethroplasty technique on the incidence of urethrocutaneous fistula (p = 0.063). There was no significant difference between the degree of chordee and complications of urethrocutaneous fistula after urethroplasty (p = 0.677). The relationship between the use of silastic stent, catheter, or cystostomy type was also not significant in complications of urethrocutaneous fistula (p = 0.576). The location of the urethral meatus also did not have a significant role in predicting the incidence of post-urethroplasty urethrocutaneous fistula (p = 0.169). Conclusion: Surgical technique (one stage and two stages), type of stent, degree of chordee, and location of the urethral meatus, did not have a significant correlation with the incidence of urethrocutaneous fistula in hypospadias patients after urethroplasty.

Comparative analysis of one- and two-stage urethroplasty in the treatment of proximal hypospadias in children: flap or transplant?

BACKGROUND: Surgical treatment of proximal forms of hypospadias in children is still a complex and largely unsolved problem. The large number of postoperative complications following reconstructive surgery for proximal forms of hypospadias supports scientific interest in this issue.&#x0D; AIM: This study aimed to conduct a retrospective comparative analysis of the effectiveness of two types of urethroplasty. We compared fundamentally different approaches to the formation of the artificial urethra, surgical techniques that use a different type of movement, and blood supply of the plastic materials a flap and a graft.&#x0D; MATERIALS AND METHODS: The study included 113 primary patients with proximal hypospadias aged 8 months to 15 years who underwent surgery between 2013 and 2019 and were divided into two comparison groups. Group 1 included 53 (46.9%) boys; a single-stage urethroplasty was performed by the onlay-tube method, where a longitudinal skin flap of the dorsal surface of the penis was used as a plastic material. Group 2 included 60 (53.1%) patients; two-stage urethroplasty was performed by the Bracka method, where the plastic material for the formation of the artificial urethra was a preputial graft in 44 (73.3%) patients and a graft of the oral mucosa in 16 (26.7%) patients.&#x0D; RESULTS: When comparing the surgical results in the form of the number of complications requiring repeated surgical interventions under anesthesia to eliminate them, corresponding to ClavienDindo 3B complications, a significant difference was obtained in the study groups. The surgical results were significantly better when performing the two-stage Bracka method.&#x0D; CONCLUSIONS: In the surgical treatment of proximal forms of hypospadias in children, the two-stage Bracka method, where the plastic material for the formation of the artificial urethra is a preputial or mucosal graft, significantly reduced the number of postoperative complications.

The modified Koyanagi technique versus two-staged urethroplasty using buccal mucosal graft in managing proximal hypospadias: a randomized clinical trial

Background One of the most challenging cases in correction is proximal hypospadias. There are many techniques used, but no technique has shown success or acceptance universally. The purpose of our study is to compare the modified Koyanagi (MK) technique and two-staged urethroplasty by buccal mucosal graft techniques in managing proximal hypospadias types regarding rate of success, postoperative complications, and cosmesis. Patients and methods A total of 40 patients with proximal hypospadias types were enrolled, and these patients underwent surgical repair using MK technique or two-stage urethroplasty using buccal mucosal graft techniques. Patients were randomized into two equal groups (n=20): group A underwent MK technique, and group B underwent two-staged urethroplasty using buccal mucosal graft techniques. The follow-up ranged from 6 to 18 months. Results The rate of success was 60% in group A compared with 75% in group B. Higher incidence of fistula was in group A (six cases) than group B (two cases), urethral stricture was the same (two cases in each group), meatal stenosis was less in group A (two cases) than group B (eight cases), and residual chordee was more in group A (two) than B (one), with no penile rotation in both groups. Conclusions The MK for repair of proximal hypospadias is a good technique and gives successful surgical results but requires meticulous technique and tedious preservation of blood supply. Two-staged urethroplasty is a technically straightforward and feasible technique, with less fistula rate, but requires more time, as a two-session operation, with good results in severe chordee and success rate.

Comparative study of one-stage and the novel two-stage urethroplasty using the transected urethral plate and transverse preputial island flap (TPIF) for severe hypospadias: a single-center experience.

BackgroundTo evaluate a novel two-stage method of urethroplasty using a transected urethral plate and transverse preputial island flap (TPIF) for proximal hypospadias with severe chordee.MethodsWe retrospectively analyzed 91 cases of proximal hypospadias, who had undergone either one-stage or two-stage urethroplasty. Comparisons between the two groups were made based on age, glans diameter, the length of the urethral defect, and the rate of complications.ResultsThere was no significant difference in age at surgery, glans diameter, and the length of urethral defect between the two groups. In the one-stage group, 18 cases of urinary fistula and one case each of glans dehiscence, urethral diverticulum, and urethral diverticulum with concurrent glans dehiscence, were reported. All patients were treated using urinary fistula repair or urethroplasty. In the novel two-stage group, no cases of urinary fistula were reported after the secondary urethroplasty. However, 4 cases showed dehiscence at the glans, 2 were treated through reoperation but the 2 other 2 patients reoperation. The success rate was 62.50% and 88.57% in the one-stage and two-stage groups, respectively (P<0.05).ConclusionsTwo-stage urethroplasty using a tubularized urethral plate and TPIF can significantly reduce the incidence of urethral fistula of the proximal hypospadias with severe chordee. However, it may increase the number of operations that need to be performed on children who do not need staged surgery. Although we could not prove it through this study, we believe that the necessity of two-stage urethroplasty should be determined based on the development of the glans, the severity of penile curvature, and the length of the urethra defect.

АНАЛИЗ ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ ДВУХ ОПЕРАТИВНЫХ МЕТОДИК ПРИ ЛЕЧЕНИИ ПОСЛЕДСТВИЙ ТРАВМ УРЕТРЫ

Objective: To analyze the results of application of the two surgical techniques in the treatment of the consequences of urethral injuries (CUI). Methods: 38 patients aged 16.4±1.9 years with CUI were examined. CUI were localized in the area of the scaphoid fossa (n=3), the penile part (n=9), the bulbous region (n=6). Multi-site and panurethral lesions were noted in 8 and 12 cases, respectively. Additional research methods included ultrasound examination of the bladder, uroflowmetry, residual urine measurement, and, if necessary, retrograde and voiding urethrography. The patients underwent two types of surgical intervention: one-stage (16 patients, 1st group) and two-stage (22 patients, 2nd group) urethroplasty using a buccal mucosal flap. The results of surgery were assessed by ascending urethrography and uroflowmetry. The follow-up period ranged from 6 to 24 months. Results: The immediate and long-term results between the two groups showed significant difference. According to uroflowmetry data, the main indicator of the effectiveness of surgical intervention was a stable retention of maximum urine flow rate at least 15 ml/sec. In the 1st group, there was one case of early wound dehiscence with the formation of a fistula. In the 2nd group, early divergence was observed in 8 cases, it was also accompanied by formation of fistulas. These complications required additional surgical intervention; their correction was deferred. Conclusion: One-stage urethroplasty using a buccal mucosal flap for CUI proved to be safer and more effective compared to the two-stage technique Keywords: Consequences of urethral injury, urethrography, uroflowmetry, buccal flap.

Коррекция стенозов уретры после оперативных вмешательств по поводу проксимальных форм гипоспадии у детей

Aim Urethral stenosis is one of the serious complications after proximal hypospadias repair. A variety of techniques has been suggested for its correction, such as urethral dilation using bougies, endoscopic incisions and one- or two-staged urethroplasty with buccal mucosa. The aim of our study was to improve results of urethral stenosis correction in children after multiple proximal hypospadias repairs. Materials and methods A total of 24 patients with urethral stenosis after proximal hypospadias repairs underwent treatment in the Department of Uroandrology of the Russian Childrens Clinical Hospital from 2015 to 2019. The age of the patients was from 3-17 years (average - 4.2) with penoscrotal form of hypospadias in 12, scrotal in 8, and perineal in 4 patients. All children previously underwent 2-8 hypospadias repairs. Patients were divided into 2 groups. In group I, 16 patients had urethral stenosis from the glans of the penis to the penoscrotal area, urethral diameter of 3-4 Ch and ventral penile curvature of 45-60o. These patients were treated with a two-staged urethroplasty, similar to Brackas technique. In group II, 8 patients with urethral stenosis in the penile shaft area, urethral diameter of 6 Ch, without penile curvature were included. They underwent to a one-stage urethroplasty with buccal mucosa graft, which was sutured on the dorsolateral aspect of the urethra, with a formation of the age-appropriate urethra (Dorsolateral Inlay). Results All patients in both groups had successful results with flow rate of 8-12 ml/sec. Conclusions The correction of urethral stenosis in children after proximal hypospadias repairs can be performed using buccal mucosa. In cases of long urethral stenosis, urethral diameter of 3-4 Ch, penile curvature, and scarring of the penile skin, a two-staged urethroplasty is recommended. In patients with stenosis of the penile shaft, urethral diameter of 6 Ch and lack of penile curvature, a one-stage urethroplasty with buccal mucosa fixation on the dorsolateral aspect of the urethra (Dorsolateral Inlay) allows to achieve successful results.

Comparative study of one-stage and partial staged urethroplasty using transected urethral plate plus TIPF for severe hypospadias: a one-doctor experience

To explore the application value of staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap for severe hypospadias. We retrospectively analyzed 91 cases with severe hypospadias, using one-staged and two-staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap. In one-staged group, the age of surgery was 7 months to 12 years old; the length of urethral defect was 3–5cm; the diameter of glans was 1.0–1.4cm. In two-staged group, the initial operation time was 7 months–12 years old; the length of the urethral defect was 3–5cm and the diameter of the glans was 0.8–2.5cm. There was no significant difference in the age of surgery, glans diameter and length of urethral defect between the two groups. In the one-staged group, 18 cases had urinary fistula, 1 case glans dehiscence, 1 case urethral diverticulum, and 1 case had urethral diverticulum and glans dehiscence at the same time. All of them were addressed by urinary fistula repair/urethroplasty. There was no urinary fistula after secondary urethroplasty in the two-staged group. Four cases had new urethral dehiscence at the glans. 2 of them were successfully managed by reoperation, and the other’s parents did not agree to reoperation. The success rate of the one-staged operation group was 62.50%, and the two-staged group was 88.57%. There was a statistically significant difference in the success rate between the two groups. Two-staged urethroplasty by tubularization of reconstructed urethral plate using preputial island flap can significantly reduce the incidence of urethral fistula for severe hypospadias, but may increase the number of operations in children who do not need staged surgery.

Current treatment of lichen sclerosus and stricture.

Lichen sclerosus (LS) is a common cause of urethral stricture disease. The purpose of this article is to review the literature over the past 5years, to describe current treatment of lichen sclerosus as it relates to urethral stricture in men. Literature reviews were performed using PUBMED, with search terms "lichen scleros*" and "urethral stenosis", as well as "lichen scleros*" and "urethral stricture". Relevant articles published within the past 5years were selected for review. A summary of current treatment of lichen sclerosus was prepared and synthesized. For LS affecting genital skin, topical steroids are a mainstay of therapy but in advanced cases, surgery may be required such as circumcision. When LS causes urethral stricture, urethral dilatation is unlikely to be successful long term, and surgery is often required, such as meatoplasty, single- or two-stage urethroplasty, or perineal urethrostomy. Oral mucosal grafting is the graft of choice, and usage of genital skin for flaps or grafts is best avoided due to predilection for recurrence. Biopsy and long-term surveillance of LS are recommended, due to its potential association with squamous cell carcinoma development. Although debate still exists regarding the pathogenesis of LS, it is agreed that LS can pose a treatment challenge to physicians and surgeons. Treatment options for LS range from pharmacological to surgical, depending on severity and location of disease, patient factors, and response of previous treatments.

Outcome determinants of urethroplasty in the management of inflammatory anterior urethral strictures.

Limited data are available on outcomes of the surgical management of inflammatory urethral strictures secondary to infection, a major cause of stricture. Several shortcomings that need to be addressed have been identified in the past. To determine the impact of stricture length, position and degree of obliterative urethral lumen on the surgical outcomes of corrective procedures for inflammatory anterior urethral strictures. This retrospective analysis used the records of patients who presented with proven infective anterior urethral strictures at an academic hospital from 2007 to 2010. All patients were followed up after 48 months. Urethroplasty outcomes were analysed according to stricture location and length and effect of urethral obliteration. The median age of the 174 patients in the study was 47 (range 21 - 86) years. Anastomotic urethroplasty was successful in 59/99 (59.6%) patients. Augmented anastomotic urethroplasty was successful in 11/15 (73.3%) patients. Dorsal onlay buccal mucosa graft urethroplasty was successful in 23/32 (71.9%) patients, significantly higher than in 2/9 (22.2%) patients who underwent ventral onlay buccal mucosa graft urethroplasty (p=0.017; hazard ratio 3.4; 95% confidence interval 1.29 - 9.40). The one-stage circular pedicled penile skin-flap urethroplasty was successful in 1/12 (8.3%) patients. Two-stage urethroplasty was successful in 5/7 (71.4%) patients. A primary component analysis of the 73 failed procedures showed that stricture length was the main contributor to failure (eigenvalue 1.79; 45%). Urethroplasty remains a challenge in inflammatory urethral strictures, where stricture length was the main reason for treatment failure.

Better defining the optimal management of penile urethral strictures: A retrospective comparison of single-stage vs. two-stage urethroplasty

We aimed to compare single-stage and two-stage urethroplasty techniques for the treatment of penile urethral strictures. We performed a retrospective review of all penile urethroplasties performed at a single centre between 2003 and 2017. The primary outcome was urethral patency, defined as the ability to easily pass a 16 Fr flexible cystoscope at six and 18 months of followup, and development of 90-day complications. Overall, 101 single-stage procedures (48 buccal mucosal graft [BMG] and 53 penile fasciocutaneous flap [PFF]) and 53 two-stage procedures were performed. There was no difference in median stricture length between groups (p=0.25). Cox regression analysis did not identify stricture etiology, length, age, obesity, prior reconstruction, or urethroplasty technique to be associated with failure. Log-rank testing did not demonstrate a difference in success rates between surgical techniques (91% [48/53] PFF vs. 83% [40/48] BMG vs. 87% two-stage [46/53]). Thirty-nine percent (60/154) of patients experienced a complication (51% [27/53] PFF vs. 29% [14/48] BMG vs. 36% [19/53] two-stage). Multivariate analysis found urethroplasty technique to be the only factor associated with development of complication (p=0.02); odds ratio relative to BMG was 3.1 (p=0.009) for PFF and 1.4 (p=0.43) for two-stage. There appears to be little difference in success between penile urethroplasty techniques. The shift in technique to a single-stage BMG, when appropriate, appears to be founded on the basis of fewer operations for the patient, relative to a two-stage repair, and a lower complication profile, relative to single-stage PFF, without compromising success rates.

Reoperation methods and effectiveness of urethral stricture after urethroplasty of hypospadias

To discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness. Between September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation (74 cases) and urethral advancement (6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy (10 cases), urethrotomy and one-stage urethroplasty (26 cases), and urethrostomy (51 cases) including 43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis. One hundred and fifty-four patients were followed up 6-86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated. If it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.

Dorsal vertical island flap urethroplasty in children with hypospadias: a single center’s experience 75 patients

ObjectiveTo assess the results and complications of dorsal vertical island flap (DVIF) urethroplasty.MethodsA total of 175 children were operated on for hypospadias. Out of these, 41 with proximal hypospadias with...