Urethral Reconstructive Surgery Research Articles

The use of amniotic membrane injection as an adjunct in endoscopic urethral stricture management

ABSTRACT Introduction: Endoscopic urethral stricture treatment has high recurrence rates. Due to research supporting amniotic membrane’s (AMs) anti-inflammatory and anti-fibrotic properties reducing scar tissue formation, AM has generated interest in reconstructive urethral surgery. To the best of our knowledge, we performed the first investigation of the success rate of urethral dilation when combined with micronized AM injection for the treatment of urethral stricture. Methods: Eligible patients were adult males with anterior strictures meeting strict criteria for diameter, length, International Prostate Symptom Score (IPSS), and flow rate. Micronized AM was injected in the stricture region during urethral dilation. The primary study endpoint was an anatomical success (≥14Fr) at 6 months. Secondary endpoints were evaluated with the IPSS, urethral stricture surgery – patient-related outcome measure, International Index of Erectile Function, flow rate, and postvoid residual. Outcomes were assessed at baseline and multiple points postinjection. Injection safety was analyzed. Results: Ten men with a mean age of 52 years were included in the study. At 6 months, 7 of 10 patients demonstrated recurrence of the urethral stricture on cystoscopy. Improvements in secondary endpoints were noted in 10 of 10 patients at 3 months and 3 of 10 patients at 6 months. No adverse events were observed. Conclusions: To the best of our knowledge, this is the first study evaluating micronized AM injection as an adjunct treatment at the time of urethral dilation. The urethral stricture recurrence rate did not improve with the injection of AM despite the hypothesized benefits of anti-fibrotic and anti-inflammatory properties.

Initial application of near-infrared fluorescence imaging using indocyanine green in urethral reconstructive surgery

Initial application of near-infrared fluorescence imaging using indocyanine green in urethral reconstructive surgery

Tele-Urology in the Era of COVID-19: an Experience of the Reconstructive Urology Department in Iran.

The outbreak of coronavirus has put additional pressure on the health care systems of many countries; but telemedicine can be an important way to deal with it, especially for people whose health has been affected by the virus. The present study aims to investigate the Implementation of a Tele-urology Program for Reconstructive Urologic Referrals: Initial Results and Patient Satisfaction. All patients with a history of a urethral reconstructive surgery during last year was entered to our study and two nurses collected data of demographic and past medical history of patients by existed. Telephone visits:Fellowship of reconstructive urology was connected to patients during a phone call and filled the USS-PROM and COVID-19 questionnaires. Face to face visits: All patients were asked to answer the questionnaire about recent exposure and infection by corona virus, recent travel and other risk factors of COVID-19. Mean of USSPROM scale was calculated as 1.65 (+2.91) with a range of 0-15. Based on categorization for USSPROM scale, 74 patients (94.8%) had mild symptoms while 4 patients (5.1%) had moderate symptoms and needed further medical attention. Four patients with moderate USSPROM score were required to cystoscopic evaluation, which one patient with moderate USSPROM score had severe stricture and candidate for redo urethroplasty. Two other patients need for urethral stricture dilatation. Cost was calculated based on taxi-service fee. Accordingly, the average (+SD) cost for in-person visits to the physician was estimated as 4.80 + 4.32 million Rials. In terms of distance, the average distance for receiving medical services according to the patient`s residence area was 373.2 +348.79 kilometres.In terms of the patient`s opinion regarding virtual examination, inappropriateness of virtual visits for physical examination, and patient`s inability to explain the problem correctly, patient`s condition at the time of the virtual visit were the main challenges reported by the respondent. Considering that the present COVID-19 emergency will likely last for months, telehealth could be the safest way to deliver urological care for a large percentage of the patients, such as those who are more at risk of unfavorable outcomes of COVID-19.

Extracellular matrix analysis of fibrosis: A step towards tissue engineering for urethral stricture disease.

The urogenital tract is a target for many congenital and acquired diseases, both benign and oncogenic. In males, the urethra that transports urine and semen can be obstructed by a fibrotic disease called urethral stricture disease (USD). In severe USD, the whole organ including the vascular embedding, the corpus spongiosum (CS), is affected. Recurrent or severe USD is treated by reconstructive surgery. Tissue engineering may improve the outcome of urethral reconstruction in patients with complicated USD. Currently in urethral reconstruction only the epithelial layer is replaced, no substitution for the CS is provided, while the CS is important for mechanical support and vascularization. To develop a tissue engineering strategy for the CS, it is necessary to know the protein composition of the CS. As the extracellular matrix (ECM) plays an important role in the formation of fibrosis, we analyzed the distribution and localization of ECM components in human healthy and fibrotic CS tissue using immunohistology. The morphology of components of the elastic network were affected in USD. After decellularization a clear enrichment of proteins belonging to the ECM was found. In the proteomic analysis collagens COL15A1 and COL4A2 as well as inter-alpha-trypsin inhibitor ITIH4 were upregulated in fibrotic samples. The glycoproteins Periostin (POSTN), Microfibrillar-associated protein 5 (MFAP5) and EMILIN2 are downregulated in fibrotic tissue. To our knowledge this is the first proteomic study of ECM proteins of the CS in healthy and in USD. With these results a regenerating approach for tissue engineered CS can be developed, including relevant ECM proteins that reduce fibrosis and promote healthy healing in urethral reconstructive surgery.

MP78-14 INTERNATIONAL EXPERT CONSENSUS ON DEVELOPMENT OF A STATE OF THE ART MALE GENITAL SIMULATION MODEL FOR URETHROPLASTY AND ARTIFICIAL URINARY SPHINCTER INSERTION

You have accessJournal of UrologyCME1 Apr 2023MP78-14 INTERNATIONAL EXPERT CONSENSUS ON DEVELOPMENT OF A STATE OF THE ART MALE GENITAL SIMULATION MODEL FOR URETHROPLASTY AND ARTIFICIAL URINARY SPHINCTER INSERTION Andrew Cohen, Marc (Toto) Abalajon, Katherine Anderson, Nima Baradaran, Cooper Benson, William Boysen, Benjamin Breyer, Arthur Burnett, Felix Campos, Lindsay Hampson, Ty Higuchi, Niels Johnsen, Nicolaas Lumen, Dmitriy Nikolavsky, Joseph Pariser, Jay Simhan, Alex Vanni, Nick Warner, E. James Wright, and Ahmed Ghazi Andrew CohenAndrew Cohen More articles by this author , Marc (Toto) AbalajonMarc (Toto) Abalajon More articles by this author , Katherine AndersonKatherine Anderson More articles by this author , Nima BaradaranNima Baradaran More articles by this author , Cooper BensonCooper Benson More articles by this author , William BoysenWilliam Boysen More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Arthur BurnettArthur Burnett More articles by this author , Felix CamposFelix Campos More articles by this author , Lindsay HampsonLindsay Hampson More articles by this author , Ty HiguchiTy Higuchi More articles by this author , Niels JohnsenNiels Johnsen More articles by this author , Nicolaas LumenNicolaas Lumen More articles by this author , Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author , Joseph PariserJoseph Pariser More articles by this author , Jay SimhanJay Simhan More articles by this author , Alex VanniAlex Vanni More articles by this author , Nick WarnerNick Warner More articles by this author , E. James WrightE. James Wright More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The number of available simulation-based models for technical skills training in urology is rapidly increasing, and development of training around these procedures should follow a structured approach. Utilizing modern education theory previously used to develop a hydrogel model for penile prosthesis placement, we aim to establish the criteria for development of a hydrogel male genital simulation model for Urethroplasty and Artificial Urinary Sphincter Insertion using international expert consensus. METHODS: 19 international experts of genitourinary reconstructive surgery were invited to participate in a three phase consensus building approach (modified Delphi technique). A total of 39 unique questions with 155 sub questions over three rounds were included in 4 categories 1) Overall utility of the model 2) anatomical and procedural components, 3) tissue fidelity and 4) evaluation of performance. Components reaching a content validity index (CVI) ≥0.80 were utilized to fabricate a prototype model. RESULTS: 106 of the 155 (68.3%) questions reached the consensus benchmark. Regarding utility, consensus was reached that a non-biohazardous urethral model and simulation-based platform would be very beneficial and should be developed using a validated educational approach. The expert panel agreed the simulator should allow for surgical practice in a risk free environment and allow performance evaluation. Consensus was reached on key anatomical components (Table 1) including an initial training focus of a 2 cm proximal bulbar stricture. The panel agreed a model should allow flexible application of urethroplasty techniques such as grafts. The addition of an obturator canal was prompted from the group given desires for future urethral sling simulation. Furthermore, the experts approved a framework for a standardized evaluation metric for urethroplasty. They agreed motion analysis wearables for efficiency of movement and retrograde infusion test for anastomotic integrity have value as objective standardized feedback. CONCLUSIONS: Harnessing the consensus of 19 international experts, the framework for a robust and bio-safe model for reconstructive urethral surgery with proposed objective evaluation parameters of surgical performance was achieved. Fabrication of the prototype based on this consensus statement is in development. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1137 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Cohen More articles by this author Marc (Toto) Abalajon More articles by this author Katherine Anderson More articles by this author Nima Baradaran More articles by this author Cooper Benson More articles by this author William Boysen More articles by this author Benjamin Breyer More articles by this author Arthur Burnett More articles by this author Felix Campos More articles by this author Lindsay Hampson More articles by this author Ty Higuchi More articles by this author Niels Johnsen More articles by this author Nicolaas Lumen More articles by this author Dmitriy Nikolavsky More articles by this author Joseph Pariser More articles by this author Jay Simhan More articles by this author Alex Vanni More articles by this author Nick Warner More articles by this author E. James Wright More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...

Multi-stage surgery for anterior urethral strictures: assessment of immediate and long-term surgical outcomes

BACKGROUND: The progress made in reconstructive urethral surgery over the past 20 years has shown the effectiveness of one-stage repair of anterior urethral strictures. Nevertheless, multi-stage urethroplasty retains its primary role in the treatment of patients with the most complex urethral narrowing and obliterations.
 AIM: To evaluate the immediate and long-term surgical results of multi-stage urethroplasty for penile and bulbar urethral strictures.
 MATERIALS AND METHODS: The study included 110 men aged 1884 years who underwent multi-stage urethroplasty for the anterior urethral structures in 20102019. The techniques of buccal and skin augmentation or urethral replacement plastics were applied. Before surgery, all patients underwent a standard urological examination. Early surgical complications were evaluated from medical records. Late surgical complications were determined according to examinations that included symptomatic assessment with specialized questionnaires, laboratory tests of serum and urine, physical examination, uroflowmetry, and retrograde urethrography and ureteroscopy (if urinary disorders were detected). The median follow-up was 5 years and 2 months.
 RESULTS: Early surgical complications were detected in 27 (24.5%) patients. Surgical interventions to resolve them were required in 7 (31.8%) cases: urethrocutaneous fistulas (5), acute urinary retention (1), scrotal hematoma (1). Late surgical complications were detected in 33 (30.0%) patients, including 29 (26.7%) cases of recurrent urethral strictures. All late complications cases were classified as Clavien-Dindo IIIb, and a total of 49 additional operations were performed to eliminate them. The primary success rate for multi-stage urethroplasty was 67.3 % with a median follow-up of 62 months. Only 73 (66.4%) completed all stages of the planned surgery. Urethral integrity throughout its entire length was restored in 67 (60.9%) cases, spontaneous urination in 106 (96.4%) cases.
 CONCLUSIONS: Multi-stage surgery for anterior urethral strictures is associated with relatively high risks of surgical complications at each stage of treatment. The probability of surgical revision of complications can reach 31.8%. Patients should be informed about the risks of developing surgical complications and the potential for more than two surgeries to achieve treatment goals when planning multi-stage urethroplasty.

Role of Testosterone in Urethral Reconstructive Surgery

The field of urethral reconstructive urology continues to advance itself with innovation in both surgical technique and technology. Industry continues to improve on its devices, (ie, penile implants, slings and artificial sphincters), making them more effective and more durable, minimizing failures. Surgeons spend years training to hone their surgical technique. However, to maximize operative outcomes, the 3 pillars that play a primary role includes not only (i) the surgeon and his/her surgical skill/technique, (ii) the device itself, but also (iii) the patient him(her)self.

A new approach to use of oral mucosa in reconstructive urethral surgery: micrografts

Introduction. Treatment of patients with complex urethral strictures is an actual problem of reconstructive urology. After multi-staged urethral surgery with multiple revisions the new reconstruction is limited by paucity of plastic material (for grafts and flaps). In-thing, new materials for urethral reconstruction (various auto, allo and xenografts) are still being developed in reconstructive urethral surgery. Purpose of the study . To study the possibility of using oral mucosa micrografts to form the urethral plate in the multi-stage surgery for patients with extended urethral strictures. Materials and methods. In the experimental study, male Wistar rats (22 individuals) weighing 300 – 400 g underwent a full-thickness skin wound after intramuscular sedation. We used the wound chamber (12 mm diameter) to exclude the wound contraction. The oral mucosa graft was harvested (6 mm in diameter). After pre-fabrication, the graft was minced to fragments < 1 mm 2 . Micrografts with fibrin-thrombin glue were applied to the wound. By day 45, the epithelial plate was excised for histological examination. In the clinical study, 4 patients with recurrent penile urethral strictures were treated with staged urethroplasty with urethral plate formation using oral mucosa micrografts. The average length of the stricture was 7.5 ± 1.2 cm (with extremely narrow and obliteration sites). The urethral plate was formed as the first stage. The preparation of the graft bed and oral mucosa grafts harvesting was carried out according to the standard procedure. Micrografts preparation and implantation was carried out as in experimental part of this study. After 6 months, neourethra tubularization was performed. The patients were evaluated every 3 months after the final stage of urethroplasty (uroflowmetry, ultrasound, X-ray, PROM-USS). The median follow-up was 9 months (3 – 18 months). Results. On day 15, in the experimental study, in 16 of 22 (72.7%) rats, the wound chambers had focal growth of the oral mucosa epithelium. On day 45, the wounds healed completely healed with oral mucosa. The final area of the plate was 78 ± 12 mm 2 . In the clinical study, 6 months after the first stage, all patients (n = 4) had a urethral plate covered with an oral mucosa epithelium without scar formation and sufficient for neurethra tubularization. All patients underwent urethral tubularization. After catheter removal, all men urinated. After 9 months (median follow-up, n = 3), the Q max was 22.7 ± 4.2 ml/s, the post-void residual urine was 34.8 ± 2.2 ml, the total PROM-USS score was 7.4 ± 1.2, urethral lumen is preserved. All patients showed high satisfaction with the treatment. Conclusion. The oral mucosa micrografts showed good take in heterotopic transplantation (72.7%) with the formation of an epithelial layer on the wound surface. The final mucosal plate area 3 times exceeded the initial micrografts area. This initial clinical experience of using oral mucosa micrografts shows the new possibility of this technology in reconstructive urethral surgery, especially in patients with complex urethral strictures.

Female Urethroplasty: Outcomes of Different Techniques in a Single Center.

Introduction: Female urethral strictures and injuries are relatively uncommon compared to males. A wide range of possible causes and treatment modalities have been described. Lately female urethral reconstruction is gaining attention and is fortunately no longer a neglected topic within the reconstructive urology. As such, we aimed to describe our surgical techniques and outcomes for female urethroplasty from a tertiary center. Materials and Methods: Records of female patients who underwent a urethroplasty between July 2018 and May 2021 in our tertiary referral center were reviewed. Patients were subdivided in two groups: patients who suffered from a urethral injury and received an early repair urethroplasty, and patients with a true urethral stricture who received a delayed urethroplasty. Preprocedural, surgical and postoperative data were collected and analyzed with descriptive statistics. Results: A total of five patients in group 1 and nine patients in group 2 were included. Etiology of the urethral injury in group 1 was iatrogenic in 80% and transitional cell carcinoma of the urethra in 20% of cases. A patency rate of 100% at a follow-up of 30 months was achieved with the different techniques. In group 2 etiology was idiopathic (44%), iatrogenic (44%) and due to external trauma in 12% of cases. Urethroplasty technique consisted of primary repair or dorsal onlay of a buccal mucosal graft. Patency rate was 100% at a median follow-up of 13 months. Three patients suffered from postoperative urinary incontinence, one in group 1 and two in group 2. Conclusion: Female urethroplasty is a relatively rare entity within reconstructive urethral surgery. This case series of 14 patients demonstrates that with appropriate surgical techniques, a high patency rate with a low complication rate can be achieved. Further prospective studies with standardized diagnostic workup and follow-up should be performed in order to optimize management strategy.

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.

Delayed Anastomotic Urethroplasty in Children and Adolescence with Pelvic Fracture Urethral Injury (PFUI): Experiences in Two Centers of Reconstructive Urethral Surgery in Indonesia

Introduction: Incidence of pediatric pelvic fracture urethral injury (PFUI) is rare. This study reviews the experience of anastomotic urethroplasty surgery in children and adolescence PFUI in the last 3 years in two center of reconstructive urethral surgery in Indonesia. Method: This study retrospectively reviewed PFUI cases in Hasan Sadikin Hospital and Saiful Anwar Hospital from 2013-2016. The data cases were analysed base on aetiology of the trauma, urethral gap, and previous operations. The operation time and intra operative additional procedure to achieve tension free anastomotic was also noted. Result: A total 31 children and adolescence patients with PFUI were recorded in two institutions. Twenty patients were in Hasan Sadikin Hospital while 11 patients were in Saiful Anwar Hospital. The trauma mechanisms for PFUI were 28 (90.3%) cases due to motorcycle accidents and 3 (9.7%) cases due to high falls accidents. All patients underwent delayed urethral reconstruction in median 6 months (3-72). The median operation time was 150±101 minutes for children and 160±50.5 minutes for adolescence. The average length of the urethral gap in children cases was 2.8±1.2 cm, meanwhile 4±1.9 cm for adolescence cases. In order to achieve the tension free of anastomotic urethroplasty, 5 (16.1%) of PFUI patients underwent crural separation, 16 (51.6%) patients underwent inferior pubectomy and 3 (9.7%) patients for supracrural re-routing. Posterior pubectomy with omental wrap via transpubic approach was performed in one patient. The success rate for children cases was 83.3% and 88% for adolescence cases. Thus, the overall success rate after anastomotic urethroplasty for pediatric PFUI was 83.9%. Conclusions: In short-term follow up, delayed repair urethral reconstructive surgery by transperineal and transpubic anastomotic urethroplasty in children and adolescence with PFUI achieved a significant good result and showed promising outcome.

Comparison of Epidural Dexmedetomidine Versus Ropivacaine Infusion Effectiveness in Preventing Erection Following Reconstructive Urethral Surgery: A Randomized Clinical Trial.

BackgroundOne of the most common devastating problems that occur after urethroplasty is erection, which causes surgical complications (fistula, wound dehiscence, and surgical graft failure) and the need for repairing the complications. We attempted to compare the effect of continuous epidural infusion of dexmedetomidine and ropivacaine as a post-surgical erection prevention strategy.ObjectivesIn this study, we aimed to compare the effect of dexmedetomidine and ropivacaine epidural infusion on the incidence of erection after reconstructive urethral surgery.MethodsAn RCT was conducted on 45 patients who were scheduled for reconstructive urethral surgery. They were randomly divided into three groups: (1) control (n = 15), (2) epidural dexmedetomidine (n = 15), (3) and epidural ropivacaine (n = 15). The control group received oral medication after surgery according to the conventional method (cyproterone compound tablets 50 mg BD and diazepam tablets 2 mg TDS for a week) to prevent erection. The DEX group received dexmedetomidine as continuous epidural infusion, and the ROP group received ropivacaine in addition to the conventional method. The occurrence of erection during day and night was recorded separately until the seventh day after surgery. Due to the long-time interval between case selection, participants from different groups were not matched with each other.ResultsThe incidence of erection in the dexmedetomidine group was lower than that in the ropivacaine group per person (0.87) and significantly lower than in the control group (2.8 per person). Also, there was significantly less erection in the ropivacaine group (1.2 per person) than in the control group. Our study showed that erection after surgery significantly decreased with the continuous epidural infusion of dexmedetomidine and ropivacaine.ConclusionsDexmedetomidine seems to have a significant preventive effect on erection after reconstructive urethral surgery.

P0386 - Urethral reconstructive surgery: First results of a Bioreactor engineered human urethral implant in a minipig model

P0386 - Urethral reconstructive surgery: First results of a Bioreactor engineered human urethral implant in a minipig model

Outcome of urethral reconstruction among vesico-vaginal fistula patients: a cross-sectional study

BackgroundObstetric fistula (OF) complicated by urethral loss (UL) poses a challenge to both the fistula surgeon and obstetric fistula patient. The involvement of the urethra and urethral closure mechanism in OF is an important determinant of successful closure of fistula and restoration of urinary continence. OF with UL is often associated with unsuccessful repair outcome. We describe urethral reconstruction in genital tract fistula patients with UL and the outcomes of the repair.MethodsAim To review the clinical characteristics and outcome of vesico-vaginal fistula associated urethral loss following urethral reconstruction.This was a descriptive cross-sectional study conducted at the University College Hospital, Ibadan, Nigeria. A 5-year prospective data of all vesico-vaginal fistula patients with urethral loss (2011–2016) were reviewed and analysed. Data collected include socio-demographic and obstetric characteristics; cause of the fistula; and fistula characteristics—type of fistula, number of previous repairs, urethral loss, outcome of repair and follow-up. Data were entered and analysed using IBM SPSS version 20.ResultsUrethral loss occurred in 23 (15.3%) out of 150 women with OF; these women had urethral reconstruction surgery. The commonest type of urethral loss encountered in this cohort was proximal urethral loss which was seen in 12 (52.2%) patients. The most common types of fistula seen with urethral loss were large vesico-vaginal fistula (34.8%) and mid-vaginal fistula (26.1%). More than half of the women (56.6%) had previous unsuccessful repair at other facilities before presentation. The fistula closure rate was high (82.6%) regardless of type of urethral loss. Among the women with successful closure of OF with UL, about 36.8% had urinary stress incontinence post-fistula repair.ConclusionUrethral loss appears to be a rare complication of obstetric fistula. Successful closure with stress incontinence was seen in a sizeable number of women with OF with UL. Preoperative assessment for determinant of post-repair incontinence and surgical repair by experienced surgeons will improve successful outcome of repair in women with obstetric fistula with UL.

Patient-reported outcomes after buccal mucosal graft urethroplasty for bulbar urethral strictures: results of a prospective single-centre cohort study.

To describe patient-reported outcome measures (PROMs) after buccal mucosa graft (BMG) urethroplasty. We prospectively collected PROMs in patients who underwent BMG urethroplasty for bulbar urethral strictures between October 2009 and February 2017. Preoperatively and at the first, second and third postoperative follow-up visits, patients completed five PROM questionnaires: the International Prostate Symptom Score (IPSS); the IPSS Quality of Life questionnaire; the Urogenital Distress Inventory Short-Form questionnaire (UDI-6); the International Index of Erectile Function (IIEF)-5 questionnaire, combined with IIEF-Q9 and IIEF-Q10 for assessing ejaculatory and orgasmic functions; and the International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) questionnaire. In addition to using these questionnaires, we evaluated maximum urinary flow rate (Qmax ), post-void residual urine volume and total voided urine volume at each follow-up visit. Buccal pain and discomfort were assessed using a visual analogue scale (VAS). Comparison of questionnaire scores was performed using a paired Wilcoxon rank-sum test. Treatment failure was defined as any need for urinary diversion or urethral instrumentation after surgery. A total of 97 patients met the inclusion criteria. The first postoperative follow-up visit was at a median of 2.1months (n = 97/97), and the second and third visits were after a median of 7.8 (n = 82/97) and 17.0months (n = 70/97), respectively. Significant improvements compared to baseline were observed in IPSS, and IPSS-QOL, UDI-6 and ICIQ-LUTS-QOL scores at the first follow-up, and remained improved during the follow-up period (P ≤ 0.001). Patients with mild to no baseline erectile dysfunction experienced a significant decline in erectile function at the first follow-up (median [interquartile range {IQR}] preoperative IIEF-5 score 23.0 [21.0-25.0] vs median [IQR] IIEF-5 score at first follow-up 19.5 [16.0-23.8]; P ≤ 0.001). This decline fully recovered during further follow-up (median [IQR] IIEF-5 score at third follow-up 24.0 [20.5-25.0]; P = 0.86). No significant changes in median orgasmic and ejaculatory function were noted. The first postoperative median (IQR) VAS score was 3.0 (2.0-4.45), and a significant improvement in local pain and discomfort was observed during the follow-up (median [IQR] VAS at third follow-up: 0.0 [0.0-1.0]; P ≤ 0.001). Nine patients (9/97; 9.3%) had treatment failure. Stratifying recurrence based on a difference of <10mL/s vs ≥10mL/s between preoperative and postoperative Qmax could not demonstrate a significant difference (P = 0.06). Significant improvements in voiding symptoms and quality of life after surgery were reported. Patients with good baseline erections recovered erectile function during follow-up, although a significant decrease in erectile function was observed at the first follow-up. This study highlights the importance of PROMs in urethral reconstructive surgery, emphasizing that success should not be defined only by stricture-free survival.

453 - Evaluation of a collagen cell carrier for urethral reconstructive surgery using a biological simulation model

453 - Evaluation of a collagen cell carrier for urethral reconstructive surgery using a biological simulation model

MP35-01 INTERNAL URETHROTOMY AS PRIMARY TREATMENT FOR UNTREATED BULBAR URETHRAL STRICTURES

INTRODUCTION AND OBJECTIVE: Direct visual internal urethrotomy (DVIU) represents the most common surgical procedure for urethral strictures’ repair. Nevertheless, since the selection of the patients, follow up criteria, and assessment of success and failure are not homogeneous, the evaluation of short and long-term outcomes after DVIU appear challenging. The aim of this retrospective study is to investigate the outcomes and identify the predictors of failure for DVIU as primary treatment for untreated bulbar urethral strictures, performing a multivariable analysis of the results of DVIU in a homogeneous series of patients who underwent a strict follow up after surgery. METHODS: A retrospective descriptive analysis on a cohort of patients who DVIU in a referral center for reconstructive urethral surgery was performed. Patients who underwent DVIU for untreated bulbar urethral strictures with a 12 months’ follow-up were included. The primary outcome was treatment failure, defined as any postoperative instrumentation. All patients underwent preoperative evaluation using urine culture, uroflowmetry, post-void residual (PVR), retrograde urethrogram, voiding cystourethrogram, and urethral ultrasonography. Follow-up visits were scheduled every 4 months in the first year and every 6 months later including urine culture, uroflowmetry and PVR. Statistical analyses consisted of Kaplan-Meyer plots to depict treatment-failure free survival and univariate and multivariable Cox regression analysis to test the association between predictors and treatment failure. RESULTS: 136 patients were included. The median stricture length was 2 cm. Median follow-up was 55 months. At 5-years follow-up failure-free survival rate was 57%. At univariate analysis, presence of diabetes, non-idiopathic etiology, stricture length of 3-4 cm, and pre-operative maximum flow were significantly associated with treatment failure (p value <0.00001). These predictors were included at multivariable analysis, where pre-operative maximum flow was the only significant predictor of treatment failure. Patients were stratified into three groups based on pre-operative maximum flow: ≤5ml/s, 5-8 ml/s, ≥8 ml/s. Failure-free survival at 5 years after surgery was significantly different in the three groups: 31% vs. 53% vs. 83% (p<0.00001). Similarly, stratifying according to stricture length (1-2 cm vs. 2-3 cm vs. 3-4 cm), a significantly different treatment failure-free survival was observed at 5 years (71% vs. 51% vs. 39%; p<0.00001). CONCLUSIONS: The failure of internal urethrotomy for untreated bulbar urethral strictures depends on pre-operative maximum flow at uroflowmetry. Patients with pre-operative maximum flow>8ml/s have a high rate of success, and patients with maximum flow<5 ml/s have low chances of success. The success rates of DVIU as primary treatment in patients with stricture lengths of 1-2 cm compared to longer strictures was statistically significant, however the use of DVIU for untreated bulbar urethral stricture should be suggested only in selected cases. Source of Funding: None

Оценка клинической эффективности реконструкции уретры после неудачных операций по поводу гипоспадии

Evaluation of surgical treatment of hypospadias is one of the most controversial problem in urology, considering a lack of continuity in the management of these patients between pediatric andrologists and general urologists. Patients who undergone to multiple hypospadias repairs remain one of the most difficult categories for reconstructive urethral surgery and urology in general. The treatment results of 112 adult patients who had complications of previously performed hypospadias repairs were evaluated. The results of repeated procedures were compared in patients, in whom modified balloon urethral catheter (group 1; n=50) or standard Foley catheter (group 2; n=62) was used, respectively. Most patients after surgery assessed the appearance of the penis as "good" (92% in group 1, 77.4% in group 2). In group 1, satisfactory results was seen in 8% of cases and there were no unsatisfactory results, while in group 2, where standard Foley catheter was used, these values were 19.4% and 3.2%, respectively. In group 1, complication rate was lower than in group 2 (10% versus 41.9%; p<0.05). In group 1, there was a significantly higher proportion of patients with a Qmax score of more or equal 18 ml/s (90% versus 74.2%; p<0.05). Repeated procedures in adult men with late complications of surgical treatment of hypospadias are quite effective, although they are accompanied by a rather high complications rate. The use of a new model of the urethral catheter with dilating cuff and an irrigation canal allows to improve treatment results in this category of patients.

AB165. Referral patterns for urethral reconstruction surgery in Ireland—implications for service planning and provision

AB165. Referral patterns for urethral reconstruction surgery in Ireland—implications for service planning and provision

Study of treatment options in stricture urethra management and success rate in different types and sites of stricture

Background: A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen. As the constriction progresses, obstruction develops and leads to symptoms either directly related to the obstruction or as a secondary consequence.Methods: All the cases of stricture urethra presented to our institute between June 2017 to June 2019 (n=60) in whom treatment was required were studied in a prospective manner. All cases of obstructive voiding symptoms are evaluated by conducting uroflowmetry studies (ESPON, gravimetric type). Obstructive voiding symptoms are evaluated by using the American Urological Association questionnaire.Results: The data collected was divided into 3 groups: infective causes of stricture (n=22), traumatic causes of stricture (n=14) and idiopathic causes of stricture (n=24). The mean age of presentation was 34.4 years (range of 20 to 50 years). 18 (30.00%) patients had stricture in the bulbo-urethra, 12 (20.00%) at the external meatus, 4 patients had stricture at the bulbo-membranous region. Procedures undertaken during the study were visual internal urethrotomy in 20, anastomotic urethroplasty in 17 patients and Augmented urethroplasty in 23 patients. In our series of 60 patients, 48 patients had a Qmax of &gt;15 ml/sec. Average success rate was 80.1%, 12 patients had a Qmax of &lt;15 ml/sec.Conclusions: It is unwise to make sweeping recommendations for best practice for reconstructive urethral surgery based on the literature because each patient clearly requires an individualized approach based on individual circumstances. Buccal mucosa is the most widely used graft has excellent results in all types of urethroplasty.