Urethral Stricture Research Articles

Feasibility, efficacy, and safety of retrograde intrarenal surgery in <1-year age group: A single-center experience

Purpose: Urolithiasis in infants is uncommon. Percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and retrograde intrarenal surgery (RIRS) are the management options. RIRS is the least studied of these options in infants. In our series of 23 cases, we aim to assess the feasibility, efficacy, and safety of RIRS in <1-year age group. Materials and Methods: This was a retrospective analysis of a series of 23 infants who underwent RIRS in our hospital from January 2018 to March 2021. Children who were <12 months of age and had the largest stone size of <20 mm were included in the study. Results: Twenty-three patients (male – 15; female – 8) were included in the study. The mean age was 10 ± 2.31 months (range, 4–12 months). The mean stone size was 11.6 ± 2.96 mm (range, 7.5–19 mm). The mean operative time was 29.44 ± 7.45 min (range, 17–42 min). Six patients (22.2%) had mild hematuria (Clavien I), and seven patients (25.9%) had postoperative fever. Stone size had a significant positive correlation with laser time, operative time, and intraoperative intravasation, but no significant association with stone-free rate. At 2-month follow-up, 4 (three patients) out of 27 renal units had residual stones (stone-free rate [SFR] – 85.1%). No patient had long-term complications like urethral or ureteric stricture or stone recurrence during the given follow-up period. Conclusion: RIRS is a feasible and minimally invasive treatment for renal stones in infants with acceptable SFRs.

259 - Ventral inlay versus dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture; Randomized control trial

259 - Ventral inlay versus dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture; Randomized control trial

Reply to Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Reply to Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

From failure to success: management of recurrent urethral strictures with buccal mucosa graft

From failure to success: management of recurrent urethral strictures with buccal mucosa graft

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Patient-reported outcomes after one-stage neourethral reconstruction in transmen with phalloplasty-associated strictures and fistulas

IntroductionUrethral strictures and fistulas arising after gender-affirming surgery in transmen require meticulous management strategies. This study evaluates the safety and efficacy of urethral reconstruction and patient satisfaction post-surgery.MethodsA retrospective analysis examined peri- and postoperative data from transmen undergoing urethral reconstruction for urethral fistula and/or strictures at the distal urethral anastomosis between December 2017 and April 2023. Follow-up involved clinical examinations, uroflowmetry, and voiding cystourethrography. Patient satisfaction and quality of life were assessed using USS PROM and ICIQ-S questionnaires.ResultsAmong 25 patients, 88% (n = 23) had urethral fistulas, and 48% (n = 12) had urethral strictures. 41% of fistula patients also had strictures, while 75% of stricture patients had concurrent fistulas. Previous surgeries for fistula or stricture repair were noted in 26% of cases. Techniques for stricture included modified flap (50%), buccal oral mucosal grafting (33%), and primary anastomosis (17%). Post-operative urethrogram revealed urethral strictures in 15% (n = 3) and urinary extravasation in an equal number. Postoperative uroflow parameters showed improvement (Qmax 18 ml/s, Qave 7.9 ml, time 37 s, volume 332 ml). Perioperative complications were low (n = 6, 24%), all grade one (Clavien-Dindo). Follow-up revealed that 33% required another surgical intervention. The mean six-item LUTS score was 6.7 (SD 3.9). Mean ICIQ-S overall satisfaction score was 8.6 (SD 1.6) and outcome score was 20 (SD 2.8).DiscussionOur study found a significant recurrence rate of urethral strictures and fistulas post-surgery. Despite this, patient satisfaction remains high and complications are generally low-grade, highlighting the importance of expert surgical intervention.

Correlation Between Urethral Length and Urethral Stricture After Transurethral Resection of Prostate

Aim: To show the effects of urethral length, and surgical or patient related parameters on urethral strictures after Transurethral Prostate Resection (TURP). Materials and Methods: The study included 127 patients who underwent TURP for benign prostate hyperplasia (BPH) unresponsive to medical treatment in our clinic between May XXX and February XXX. The patients were separated into two subgroups as those who underwent second surgery because of urethral stricture and those who did not. These two groups were compared in respect of age, height, weight, total prostate specific antigen, fall in hemoglobin values, increase in urine peak flow rate, decrease in the post-micturition residual volume, prostate volume, operating time, tissue amounts, resection rate, and urethral length. Results: Urethral stricture was determined in 13.4% of the patients. A statistically significant difference was determined between the two groups in respect of age and urethral length (p

Применение большого количества методов оперативного лечения стриктуры уретры у одного пациента: клинический случай

Introduction. Insufficient surgical experience and inadequate choice of surgical treatment options may be the reasons for the failure of treatment of urethral stricture. In this regard, a clinical case from our practice is very indicative. Case: The article is devoted to the description of a clinical case of urethral injury in a man who, at the age of 22 years, suffered a fracture of the pelvic bones as a result of a traffic accident. From the moment of injury to the final operation, the following types of surgical interventions were sequentially performed in this patient: anastomotic endto-end urethroplasty, augmentation urethroplasty using a skin graft, augmentation urethroplasty using a graft of the tunica vaginalis of the testicle, bougienage of the urethra, urethroplasty with a vascularized radial fasciocutaneous flap on a vascular pedicle, 2-stage urethroplasty using a graft of the buccal mucosa according to the type of Bracka I and II operations, perineal urethrostomy. Urethrostomy became the final option for urine diversion; no recurrence of urethral stricture was observed during 4 years of follow-up after urethrostomy. Conclusion. Until recently, the lack of uniform approaches to the treatment of urethral stricture has led to the use of inadequate methods of surgical treatment in various clinics. The recent approval of federal clinical guidelines for urethral stricture should help optimize the treatment of this disease. Keywords: urethral stricture, urethroplasty, urethrostomy

The relationship between heart failure and smoking, and development of urethral stricture

The relationship between heart failure and smoking, and development of urethral stricture

Functional outcomes after supra-pubic phalloplasty

BACKGROUNDA thorough evaluation of the functional outcomes resulting from supra-pubic phalloplasty (SPP) assessing different aspects of the phalloplasty has not been reported. PURPOSE OF THE STUDYTo report the outcomes on sexuality, urinary function, satisfaction, and regrets following an SPP performed at our centre. SUBJECTS STUDIEDAll consecutive patients who underwent the 3-steps technique of pre-expanded SPP between 2007 and 2018 and who had at least 1 year of follow-up. METHODSQuestionnaires were sent to analyse several domains of penile reconstruction: sexuality, urinary function, perceived sensitivity, and satisfaction. Sexuality was evaluated using the Self Esteem and Relationship (SEAR) questionnaire. Urinary function was analysed based on the urethral stricture surgery PROM (USS-PROM) questionnaire. MAIN FINDINGSA total of 77 patients were included, 92.2% were transmen, and 33 (42.9%) responded to the questionnaire. Urethral lengthening (UL) was performed in 28 (36.4%) procedures and erectile prosthesis was implanted in 42 patients (54.5%). The mean length of the neophallus was 15.3cm (SD 2.6) and the mean girth was 11.8cm (SD 2.1). The mean total SEAR score (/100) was 73.8 (SD 26.7). The mean six-item LUTS score (/24) was 8.4 (SD 4.6). The standing position was the usual voiding position reported by 11 patients (73.3%). CONCLUSIONPre-expanded SPP is a robust technique that can achieve substantial flap dimensions, leading to high satisfaction with neophallus appearance and the choice of the phalloplasty technique. Overall sexual outcomes are mostly favourable. UL is feasible and effective in terms of voiding in a standing position.

A pilot study to evaluate the combination of surgery and brachytherapy for local tumor control in young children with perianal rhabdomyosarcoma

BackgroundPerianal rhabdomyosarcoma ((P)RMS) are rare and have a poor prognosis. Data in young children are limited and local therapy is not well defined. Combined brachytherapy and surgery is routinely being used for RMS at other sites in children as it provides good oncologic outcomes and allows for organ-sparing surgery. The objective of this study was to evaluate this combination treatment for local tumor control and organ-sparing surgery in young children with (P)RMS. MethodsA retrospective review of the medical records of all children who underwent surgery and brachytherapy for (P)RMS at our institution since 2009 was conducted. ResultsSurgery for (P)RMS was performed in 6 patients at a median age of 19 months (range 8–50). Embryonal RMS was diagnosed in 4 patients and alveolar RMS in 2 patients, of which 1 patient had FOXO1 fusion-positive RMS. All patients underwent postoperative high-dose rate (HDR) brachytherapy. Organ-preserving surgery was achieved in 5 of 6 patients (83 %). In 1 patient, the entire sphincter was infiltrated, making organ-preserving resection impossible. 5 of 6 patients (83 %) exhibited an event-free and overall survival at a median follow-up of 26 months (range 8–107). One patient died due to locoregional recurrence. Complications were urethral leakage in 1 patient followed by urethral stenosis and delayed wound healing and vaginal stenosis in another patient. No patient reported fecal incontinence. ConclusionsCombined treatment with surgery and HDR brachytherapy is feasible in very young children with (P)RMS and leads to a favorable oncologic outcome. Preliminary data show a good functional preservation.

Application of modified grafted tubularized incised plate urethroplasty in hypospadias

To investigate the clinical feasibility and effectiveness of the modified grafted tubularized incised plate urethroplasty (G-TIP), namely "glans G-TIP (GG-TIP) ", in treatment of hypospadias. A clinical data of 137 children with hypospadias qualified by the selection criteria between January 2021 and June 2023 was retrospectively analyzed. Among them, 75 children were treated with GG-TIP (GG-TIP group) and 62 with G-TIP (G-TIP group). There was no significant difference ( P>0.05) between the two groups in terms of age, hypospadias type, penile length, penile head width, penile head height, penile curvature, meatus-apex distance, urethral plate width, and distance from the distal endpoint of navicular groove to the dorsal or ventral midline point of the glans corona, and the difference between the two. The operation time, reconstructed urethral length, distance from meatus to ventral glans corona, postoperative complications, maximum urinary flow rate at 2 weeks after operation, and the hypospadias objective scoring evaluation (HOSE) score at 6 months after operation in the two groups were recorded and analyzed. The operation time was significantly shorter in GG-TIP group than in G-TIP group ( P<0.05); but there was no significant difference ( P>0.05) between the two groups in terms of reconstructed urethral length and distance from meatus to ventral glans corona. All urinary meatus located at the tip of glans with vertical fissure shape. All children in the two groups were followed up 6-35 months (median, 26 months). During follow-up, there were 3 cases of urethral fistula, 2 cases of urethral stricture, and 1 case of glans separation in GG-TIP group, and 3, 3, and 1 cases in the G-TIP group, respectively. There was no significant difference in the incidence of complications between the two groups ( P>0.05). The maximum urinary flow rate at 2 weeks and the HOSE score at 6 months after operation were significantly higher in GG-TIP group than in G-TIP group ( P<0.05). GG-TIP is safe and effective for repairing hypospadias in children. Compared with G-TIP, it has the advantages of relatively simple operation, shortened operation time, significant improvement in urinary flow rate, and better cosmetic results.

Urinary Leakage after Robot-Assisted Radical Prostatectomy: Is Always Predictive of Functional Results?

Introduction: The aim of the study was to evaluate if and when the presence of radiological urinary leakages of vesico-urethral anastomosis, after robotic radical prostatectomy, could provoke urethral strictures or affect continence recovery. Methods: We enrolled 216 patients, undergoing robot-assisted radical prostatectomy between January 2020 and December 2022 in three high-volume referenced centres for robotic surgery. Before removal of the bladder catheter, all patients underwent a cystourethrography in which the presence/absence of leakage was assessed at level of vesico-urethral anastomosis. Based on degree of severity of urinary leakage on cystourethrography, patients were classified as no leakage or grade 0, grade 1 with transversal diameter ≤1 cm, and grade 2 with transversal diameter ≥1 cm. At follow-up, urethral stenosis formation and urinary continence recovery were assessed; furthermore, post-operative 12-month functional outcome was determined using EORTC-QLQ-PR25 questionnaire. Results: Radiological urinary leakage was found in 30 patients with grade 1 and 33 patients with grade 2, for a total of 63 patients. Only 1 patient (1.5%), grade 2 urinary leakage, developed significant urethral stricture and required endoscopic urethrotomy after 6 months. Analysing the differences in those who removed the bladder catheter after 7–9 days and those who kept it longer, we found no statistically significant differences regarding recovery of continence (p = 0.23) or about urinary symptoms (p = 0.94). Conclusions: RARP remains gold-standard approach for treatment of localized prostate cancer and the superiority of this technique is safe in preventing urethral strictures and continence recovery, even in presence of significant anastomotic urinary leakage.

Heterogeneous porous hypoxia-mimicking scaffolds propel urethral reconstruction by promoting angiogenesis and regulating inflammation

The nasty urine microenvironment (UME) impedes neourethral regeneration by inhibiting angiogenesis and inducing an excessive inflammatory response. Cellular adaptation to hypoxia improves regeneration in numerous tissues. In this study, heterogeneous porous hypoxia-mimicking scaffolds were fabricated for urethral reconstruction via promoting angiogenesis and modulating the inflammatory response based on sustained release of dimethyloxalylglycine (DMOG) to promote HIF-1α stabilization. Such scaffolds exhibit a two-layered structure: a dense layer composed of electrospun poly (l-lactic acid) (PLLA) nanofibrous mats and a loose layer composed of a porous gelatin matrix incorporated with DMOG-loaded mesoporous silica nanoparticles (DMSNs) and coated with poly(glycerol sebacate) (PGS). The modification of PGS could significantly increase rupture elongation, making the composite scaffolds more suitable for urethral tissue regeneration. Additionally, sustained release of DMOG from the scaffold facilitates proliferation, migration, tube formation, and angiogenetic gene expression in human umbilical vein endothelial cells (HUVECs), as well as stimulates M2 macrophage polarization and its regulation of HUVECs migration and smooth muscle cell (SMCs) contractile phenotype. These effects were downstream of the stabilization of HIF-1α in HUVECs and macrophages under hypoxia-mimicking conditions. Furthermore, the scaffold achieved better urethral reconstruction in a rabbit urethral stricture model, including an unobstructed urethra with a larger urethral diameter, increased regeneration of urothelial cells, SMCs, and neovascularization. Our results indicate that heterogeneous porous hypoxia-mimicking scaffolds could promote urethral reconstruction via facilitating angiogenesis and modulating inflammatory response.

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

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

Urethroplasty- a single centre single surgeon experience.

Male urethral stricture affects 100 in 100,000 men. These are investigated using uroflowmetry, retrograde urethrography and cystourethroscopy. Management is usually endoscopic with urethral dilation or direct visual internal urethrotomy, although they have high failure rates. It is now recommended that urethroplasty is performed earlier. In this study we have reviewed a single surgeons experience with urethroplasty and patient outcomes. We retrospectively reviewed a prospectively maintained database of all urethroplasty operations performed in our hospital over a 5 -year period. Forty-five patients were identified, with a mean age of 46. The most common presenting symptom was poor flow (100%). Uroflowmetry was performed in 31 of 45 patients(69%). More patients had a urethrogram (58%) than flexible cystoscopy (38%). Most strictures were idiopathic (67%). Mean stricture length was 2.6cm. 71% did not require any further intervention. Five patients required repeat surgery. Four required DVIU and one required a repeat urethroplasty. The most popular techniques for urethroplasty in the UK are augmentation urethroplasty using a buccal mucosal graft and anastomotic urethroplasty, both of which we describe. There are variations in what is deemed as successful surgery. The most widely used definition is 'the lack of need for any further operative intervention'. We have recently adopted Patient Reported Outcome Measures using a validated questionnaire to measure the patients perception of a successful outcome. Complex strictures have a higher incidence of complications. 42% of our cohort were complex and we describe results comparable to the published literature.

Non-invasive assessment of the dynamics of change in the vascular bed in the buccal autograph during treatment of extended urethral strictures

The male urethral stricture disease treatment despite all successful achievements and treatment options still remains one of the most actual and complex problems of modern urology. The presence of prolonged urethral strictures complicated with such factors as expressed scared deformation, infection, fistulae, previous unsuccessful urethral interventions, total urethral obliteration require the use of two- or multistage operations. In the light of recent times, the improvement methods dedicated to buccal mucosa graft adaptation assessment and autotransplant microvascularity evaluation are very relevant nowadays. In this study we made an attempt to estimate the dermatoscopy role in objective assessment of buccal mucosa graft microvascular network after two staged substitutive urethroplasty.The analysis of graft microphotos made in different time periods after urethroplasty allows us to define the main thing. In our point of view, the absence of evaluation changes after 90–120 postoperative days allows us to estimate a correct time for the second stage of urethroplasty-tubularization. stages of microvasculature evolution.Considering the statement that microvasculature evolution is the evolution of its graft, we think that the correct research direction is to study microangiogenesis stimulation methods.

Urethral Stricture and Cancer

Urethral Stricture and Cancer

A Retrospective Analysis of Urethroplasty and Medical Malpractice

ObjectivesTo review malpractice suits stemming from urethroplasty intervention, which is the standard of care for patients suffering from urethral strictures. MethodsThis retrospective study analyzed the LexisNexis and Westlaw databases between 1980 and 2024. Each database was queried with “urethroplasty” which yielded 48 cases and 20 jury verdicts/settlements in the LexisNexis database and 46 cases and 14 jury verdicts in the Westlaw database. Selected cases were reviewed variables including chief allegation, litigation location, plaintiff demand, plaintiff award, and verdict. Exclusion criteria included but were not limited to lawsuits regarding non-urologic surgery necessitating urethroplasty and litigation based on traumatic injury necessitating urethroplasty. ResultsAfter manual review of 128 cases in the LexisNexis and Westlaw databases, 12 met inclusion criteria. 5 (42%) cases sued for deformation of the genitalia after urethroplasty, 2 (17%) sued for failure of informed consent, 2 (17%) sued for erectile dysfunction, 1 (8%) sued for a post-operative venous thrombosis, 1 (8%) sued for post-operative infection, and 1 (8%) sued for failure to treat. 6 (50%) cases resulted in plaintiff awards; 3 of these were settled before a final verdict. Plaintiff awards varied from $72,500 - $810,000. Of the twelve cases, 2 (17%) occurred in California and 2 (17%) occurred in Illinois; the remaining locations were isolated. ConclusionsThe most common cause of litigation following urethroplasty was centered on the perceived deformation of the genitalia after urethroplasty, which underscores the significance of urologists setting realistic expectations for patients with thorough pre-operative counseling.

Current Potential Outcomes of Buccal Mucosal Graft Anterior Urethroplasty for Male Urethral Stricture: A Single-Centre Study in Nepal.

Objective This study evaluates the efficacy and potential complications of Buccal Mucosal Graft (BMG) urethroplasty for anterior urethral stricture over a 48-month follow-up. Method A retrospective review was conducted on 130 patients who underwent various types of BMG urethroplasty between 2012 and 2019. Data on patient demographics, stricture etiology, and anatomic sitewere collected. Adverse outcomes such as complications likeerectile dysfunction (ED)persisting for over 12 months, and post-micturition dribbling (PMD) were analyzed to determine success rates, recurrent stricture risk factors, complications, and the definition of failure as stricture recurrence during the 48-month follow-up period. Results Of the 130 patients, there was a recurrence in 15.4 % (20 males), yielding a success rate of 84.6% (n=110). ED was reported in 11% (n=14) and PMD in 14% (n=18). All instances of ED were non-organic, and patients were administered oral phosphodiesterase type 5 (PDE5) inhibitors. These complications were observed in 20 patients (15.4%); with urinary fistula (3.0%), graft contracture (2.3%), graft failure (3.8%), urinary tract infection (UTI) (3.0%), and wound infection (2.3%) being the most prevalent after penile urethroplasty. Univariate analysis indicated age (31-50 years, >50 = P<0.05) at surgery, etiology (Balanitis Xerotica Obliterans (BXO)= P<0.05), stricture length (4.1-8 cm, >8 cm = P<0.05), and location as significant predictors of stricture recurrence. However, multivariate analysis highlighted penile location (P<0.05) as the sole independent predictor for restricture during the follow-up period. Conclusion BMG urethroplasty demonstrates a substantial 84.6% success rate in treating anterior urethral stricture over a 48-month follow-up period. This outcome underscores the advancements in healthcare quality in resource-limited settings in countries like Nepal.