Urethral Stricture Rate Research Articles

The Efficacy of Active Fistulation in Duckett Procedure for Proximal Hypospadias in Children.

To explore the efficacy of active fistulation in the treatment of proximal hypospadias in children by comparing one-stage and two-stage Duckett procedure. A total of sixty-seven children who were diagnosed with proximal hypospadias and underwent Duckett operation at our hospital between January 2013 and January 2021 were selected for this study. These subjects were divided into two groups: the research group (n=36), using two-stage Duckett procedure with active fistulation, and the control group (n=31), using one-stage Duckett procedure.The incidence of postoperative complications and the score of pediatric penile perception Scale were compared between the two groups. The research group exhibits significantly lower incidence rate of urethral fistula (8.3% Vs 16.1%) and urethral stricture (5.6% Vs 12.9%) in comparison to the control group (P<0.01). Furthermore, the analysis of Pediatric Penile Perception Scale scores indicates that the research group achieves significantly higher scores in terms of urethral shape, penile skin shape, and overall appearance than the control group (P<0.05). Conclusion: In the treatment of proximal hypospadias in children, The active fistulation within the two-stage Duckett procedure significantly reduces the rate of stage 1 postoperative complications and improves parental satisfaction. The active fistulation may offer a more promising option for the treatment of proximal hypospadias in children.

Short-term recurrence rate of male urethral stricture and its predictors after treatment with optical internal urethrotomy: Prospective Cohort Study at a tertiary center in Ethiopia.

Although optical internal urethrotomy is popular among the urologists due to its simplicity and safety, urethroplasty is considered the gold standard treatment for urethral strictures. This study aims to determine the 1-year recurrence rate of urethral strictures after optical urethrotomy and identify predictors of recurrence in a tertiary center in Ethiopia. A prospective observational cohort study was conducted on 80 male patients who underwent optical urethrotomy from November 2019 to August 2020 in a tertiary center in Ethiopia. Logistic regression was used to analyze the association between dependent and independent variables, with a P-value of <0.05 considered statistically significant. The mean and median age (±SD) of patients at the time of the procedure were 54.76 (±14.74) and 58 years with a range [20-78], respectively. Urethral discharge was the most common etiology identified in 39 (48.75%) of patients. Eleven (13.75%) patients had no identifiable etiology for their urethral stricture disease.The majority of patients presented with at least one voiding lower urinary tract symptoms.Sixty-eight (85%) patients out of the total had a single stricture and 12 (15%) had multiple strictures. The location of the stricture was in the bulbar urethra on cystourethrography in 83% of the patients. The 1-year recurrence rate of urethral stricture after optical urethrotomy was 35% in our study.The number of strictures and the presence of hypertension were independent predictors of recurrence of urethral stricture within 1-year after treatment with optical urethrotomy (AOR=15.35, 95% CI: 2.92-80.61, P=0.00; AOR=19.47, 95% CI: 2.11-178.98, P=0.01, respectively). Our study identified that multiple strictures, and the presence of hypertension are associated with an increased recurrence rate in the first postoperative year.

De novo urethral stricture disease in renal transplant recipients.

With routine catheterization and low urine output pre-transplant, renal transplant recipients (RTRs) may be at risk of urethral stricture disease post-transplant. The objective of this study was to characterize new urethral stricture disease in males following renal transplant. A retrospective chart review was carried out on all male RTRs at Vancouver General Hospital who developed urethral strictures from October 2009-2019. Descriptive analyses were conducted on patient characteristics. Comparative analyses against non-stricture RTRs were carried out. Of 636 RTRs, 18 (2.8%) developed a postoperative urethral stricture. Median time from transplant to stricture discovery was 56 days (range 8-618 days). One-third of stricture patients had prior risk factors for stricture formation. Post-transplant, 77.8% presented symptomatically, with 61.1% requiring intervention. Overall graft survival rate was 88.9% among the RTR stricture group; 16.7% experienced acute rejection and 22.2% had delayed graft function (DGF). There was no significant association between developing postoperative urethral stricture and urinary tract infection (Chi-squared [X2]=0.04, p=0.84; odds ratio [OR ] 0.81, 95% confidence interval [CI] 0.1-6.21), DGF (X2=0.14, p=0.70; OR 0.8, CI 0.26-2.48), or acute rejection (X2=2.02, p=0.14; OR 2.55, CI 0.71-9.12). De novo post-transplant urethral stricture rates appear to occur at a higher rate than the general population and contribute to patient morbidity. Stricture disease should be considered post-transplantation in patients with voiding dysfunction, even if they don't have prior risk factors. Multicenter studies should be considered to elucidate any relationship between urethral stricture and graft survival.

(141) Colpectomy Reduces the Incidence of Urethral Fistulas After Female-to-Male Gender Affirming Surgeries: A Meta-Analysis

Abstract Introduction The reported rate of urethral fistulas after female to male gender affirming surgeries (GAS) ranges from 10% to 68%. There remains a paucity of evidence addressing the widely accepted hypothesis that colpectomy reduces the risk of fistula formation. Objective We aim to use a meta-analysis to describe the correlation between colpectomy and the rate of urethral complications, including fistula and stricture after GAS in transgender men. Methods PRISMA guidelines were used to conduct a literature search of PubMed, Embase, Web of Science, and MEDLINE databases was conducted for studies containing words or synonyms for “trans-male”, “phalloplasty” or “metoidioplasty”, and “complications”. Inclusion criteria was specific for studies reporting postoperative incidence of urethral fistula and urethral stenosis or stricture. For those that met criteria, surgical technique, urethral complications, and outcomes were collected and analyzed using the random-effects model due to the heterogeneity of included study populations. Review Manager (Version 5.4.1) was used to perform subgroup meta-analysis between those GAS with prior or concurrent colpectomy or vaginectomy and those without. A p-value of &amp;lt;0.05 was considered statistically significant. Results 43 full-text articles meet inclusion criteria with a total of 3,929 patients. 542 (14%) of patients underwent GAS without a prior or concurrent colpectomy and 3387 (86%) underwent GAS with a colpectomy. 637 (16%) underwent metoidioplasty and 2291 (68%) underwent phalloplasty; the rest were unable to be grouped. The pooled odds ratio (OR) for urethral fistula was 0.12 (95% CI [0.06-0.21], I2 =96%, p &amp;lt;0.00001) and 0.07 for urethral stenosis (95% CI [0.03-0.15], I2 =96%, p &amp;lt;0.00001). Fistula event rate of 23.7% (930/3929) was slightly larger than the urethral stenosis event rate at 21.3% (585/2751). The OR of urethral fistula was 0.06 for GAS associated with colpectomy, compared to 1.01 with no associated colpectomy (p &amp;lt;0.00001, I2 =97%). The OR of urethral stenosis was 0.06 for GAS associated with colpectomy, compared to 0.16 with no associated colpectomy (p &amp;lt;0.41). Further subgroup analysis by procedure, showed similar findings in those who underwent phalloplasty, however no difference in the OR of fistula formation in those who underwent metoidioplasty (p &amp;lt;0.00001, p=0.33 respectively). There was no significance in the OR of urethral stricture after GAS with or without colpectomy. 5 studies showed a 100% success rate in ability to void while standing, all of which had associated colpectomy. No studies without colpectomy were available for comparison. Two studies reported a success rate of 71% and 16% showing the variability in success amongst institutions. Conclusions GAS in transgender men, including phalloplasty and metoidioplasty, with prior or concurrent colpectomy were associated with lesser odds of developing urethral fistula compared to GAS without colpectomy. There was no significant difference between the odds of urethral stricture formation in GAS with or without colpectomy. Disclosure No

One-stage repair of proximal hypospadias by in situ tubularization of the transverse preputial island flap

PurposeThis study aimed to compare the efficacy of modified transverse preputial island flap (TPIF) repair with the traditional TPIF procedure and Byar’s two-stage procedure in proximal hypospadias repair, especially in the postoperative urethral stricture incidence rates.Materials and methodsPatients admitted for proximal hypospadias treated with modified TPIF repair, the traditional TPIF procedure, or Byar’s two-stage procedure at our institution from 2017 to 2021 were identified, and the incidence of postoperative complications among them was compared.ResultsIn total, 142 patients were included (modified TPIF group, 43; traditional TPIF group, 37; and Byar’s two-stage group, 62). The length of the neourethra was 4.21 ± 0.63 cm in the modified TPIF group, 4.18 ± 0.71 cm in the traditional TPIF group, and 4.20 ± 0.68 cm in the Byar’s two-stage group. The rate of urethral stricture in the modified TPIF group (two cases, 4.65%) was significantly lower than that in the traditional TPIF group (four cases, 10.81%) (P = 0.008). Seven (16.28%) cases of urethrocutaneous fistula occurred in the modified TPIF group, six (16.22%) in the traditional TPIF group, and eight (12.90%) in the two-stage group. Additionally, one case (2.33%) of urethral diverticulum occurred in the modified TPIF group, one (2.70%) in the traditional TPIF group, and three (4.84%) in Byar’s two-stage group.ConclusionsModified TPIF repair can ensure a wedge anastomosis between the proximal urethral meatus and the neourethra, provide support and blood supply for the neourethra. Furthermore, it extended the urethral plate width at the anastomosis and urethral meatus, effectively reducing the incidence of urethral strictures.

Dorsal inlay inner preputial graft repair versus ventral-only preputial graft repair in primary distal penile hypospadias with narrow urethral plate.

Tubularized incised plate (TIP) is the most common technique used for distal hypospadias repair with good outcome but with a high rate of urethral stricture. Inner preputial-free graft can be used as an inlay graft in the incised area of the narrow urethral plate, also can be used as an onlay graft for urethroplasty in hypospadias repair to avoid this complication. A comparative prospective randomized study was conducted on two groups of hypospadias patients with narrow urethral plate. Group A: dorsal inlay inner preputial graft repair was performed (grafted TIP [G-TIP]) and Group B: ventral onlay preputial graft repair was performed. The assessment of outcome and hypospadias objective scoring evaluation (HOSE) score was done at 2 weeks and 6 months. Group A included 55 patients for whom dorsal inlay inner preputial graft repair was performed (G-TIP), and Group B which was planned to be conducted on 55 patients using onlay preputial graft (onlay graft) but was terminated after 15 cases due to high failure rate (33%). Group A showed better success rate 96% and better HOSE score (score 16) at 2 months and 6 months 83.6% and 88.2% versus 26.7% and 33.3% in Group B. Postoperative complications showed a statistically significant difference; glans dehiscence (3.6% vs. 40%), wound infection (1.8% vs. 33.3%), and skin sloughing (3.6% vs. 26.7%) in Groups A and B, respectively. G-TIP is a good technique for the management of distal hypospadias with narrow urethral plate with good success rate, cosmetic outcome, and with less complications compared to onlay graft.

Wide-based oblique anastomosis reduces urethral stricture rate following the transverse preputial island flap procedure.

The transverse preputial island flap (TPIF) procedure remains one of the classic single-stage procedures for severe hypospadias repairs. The incidence of postoperative complications remained high. This study aims to describe a modified urethral anastomosis technique during the TPIF procedure for severe hypospadias repairs and report its outcomes. Data were collected retrospectively from consecutive patients who underwent the TPIF procedure by the same pediatric urologist between January 2018 and June 2023. Collected information included age at surgery, operative details, and outcomes at follow-up. Wide-based oblique anastomosis (WOA) technique was used as a modified urethral anastomosis in all cases. In brief, the dorsal edge of anastomosis was breadthwise anchored to the corpus cavernosum with 4-5 stitches, forming a spade-shaped anastomotic surface. A total of 72 patients were included in the study. The location of the corpus spongiosum division was penile in 27 patients (37.5%) and proximal in 45 patients (62.5%). The median glans width was 13 mm (range, 6-30 mm). The median ventral curvature after degloving was 45° (range, 30-150°). At a median follow-up of 4.1 years, complications occurred in 15 patients (20.8%), including nine cases of fistula, seven cases of urethral diverticulum and two cases of meatal stenosis. No cases of urethral stricture (US), urethral dehiscence, or ventral curvature occurred. Subsequent reoperations for diverticulum repairs showed that the dorsal side of the anastomosis was extensively fixed to the corpus cavernosum, forming a wide-based, spacious lumen. WOA technique is straightforward and effective, especially in the prevention of postoperative US.

Factors Affecting Recurrence Rate of Urethral Stricture Following Internal Urethrotomy

Background: Urethral stricture (post-scarring contraction in the urethral mucosa) is among the most challenging clinical conditions in urology. In Pakistan, Urethral stricture is a high-volume disease and constitutes 4-5% of urology workload (majority of them being in the 3rd to 5th decade of life). Different urethral strictures have different management option depending upon site, size and number of recurrences. OIU is indicated for urethral stricture for small (1.5 cm) bulbar and membranous urethral stricture. However, recurrence of strictures after OIU is quite common (4 to 5%). It has been proposed that duration and size of catheter after OIU effects the recurrence rate. The foremost management choice is internal urethrotomy, but recurrences are common, and many believe that the duration and size of catheterization post internal urethrotomy may affect the recurrence rate.&#x0D; Objective: To determine the factors affecting recurrence rates of urethral stricture after internal urethrotomy.&#x0D; Methodology: It was Quasi Experimental Study conducted in Urology ward of Dr. Ziauddin University Hospital, Karachi from 10th March 2020 to 31 december 2021. Total 60 patients were included; all of the patients were divided into four equal groups. All the patients were followed quarterly for 12 months and data was recorded for urinary flow, retention, burning sensation during urination. UFM, Cystoscopy and urethrogram were done once indicated. Symptomatic patients or patients with UFM 15ml/sec were checked for recurrence followed by cystoscopy if needed. The data analysis was obtained using SPSS v. 21.0.&#x0D; Results: The mean age of the sample stood at 27 (SD ± 4) years (range: 20 to 40) years were enrolled in the study. Urethral stricture disease recurred cumulatively in 24 (40%) patients within 12 months. Mean duration of catheterization was 8.71 ± 1.1 and 2.97 ± 0.91 days in patients with and without recurrences, respectively (p=0.001). Catheter dwell times for ≥7 days was associated with increased recurrence (p=0.039). Of the patients with recurrent strictures, increased catheter diameter was also associated with higher recurrence rates (p=0.041).&#x0D; Conclusion: After careful consideration, it can be concluded that longer catheter in-dwell time and greater catheter diameter lead to a greater probability of stricture recurrence and hence the indwell time should be limited to ≤ 3 days and the catheter size chosen to be no more than 16Fr.

Evaluation of Double-Faced Tubularized Preputial Flap versus Duckett's Procedure for Repair of Penoscrotal Hypospadias with Significant Penile Curvature: A Comparative Study.

Background Proximal hypospadias, with significant curvature, is one of the most challenging anomalies. Great diversity and a large number of procedures described over the last 4 decades confirmed the fact that no single procedure has been universally accepted or successful. So, the aim of this study is to evaluate double-faced tubularized preputial flap (DFPF) versus transverse tubularized inner preputial flap (Duckett's procedure) as regards surgical outcomes, complications rate, and cosmetic results for repair of penoscrotal hypospadias with chordee. Patients and Methods. This was a prospective comparative study on 144 children with primary penoscrotal hypospadias with moderate or severe chordee, conducted at New Damietta and Assuit hospitals, Al-Azhar University, from March 2016 to March 2022. The patients were randomly divided into two equal groups; group A (n = 72) underwent DFPF, and group B (n = 72) underwent Duckett's procedure. Results No significant difference was identified as regards demographic data. The follow-up period ranged from 20 to 66 months (mean of 28 months after DFPF and 31 months after Duckett's repair), and the complication rate was 20.1% (29 of 144 children). There were statistically significant differences between the two groups as regards the urethral stricture, penile rotation, and total complication rate. HOSE score was adopted for assessment of surgical outcomes, urine stream, and cosmetic results. Conclusions The DFPF technique is feasible and reliable for one-stage repair of penoscrotal hypospadias with chordee and can be considered as a good option as it ensures better surgical and cosmetic outcomes with lower incidence of complications.

Outcomes Following Gender Affirming Phalloplasty: A Systematic Review and Meta-Analysis.

Phalloplasty is one of the genital genders affirming surgeries sought by transmasculine transgender patients during transition. Despite current advances in surgical techniques, the lack of consistency in outcomes evaluation for phalloplasty leads to significant challenges in guiding patients in clinical decision making. This systematic review and meta-analysis aims to assess outcomes for different phalloplasty surgical techniques. The literature was searched using Medical Literature Analysis and Retrieval System Online (MEDLINE; PubMed), Excerpta Medica database, and Cochrane Database of Systematic Reviews. All English-language randomized control trials, prospective and retrospective cohort studies, case series, and case reports of at least 4 patients were included. The primary outcome was postoperative complications, and the secondary outcomes were functional and aesthetic results. Proportional meta-analysis was used to pool complication rates using a random-effects model. Database searching generated 39 final articles, with 19 case series, 3 cross-sectional studies, and 17 retrospective cohort studies. A total of 1731 patients underwent phalloplasty, with the most common type of reconstruction performed being the radial forearm free flap (75.1%). Overall complication rate was high at 76.5%, of which urethral complications were high in all reconstructive subgroups (urethral fistula rate of 34.1% and urethral stricture rate of 25.4%). Postoperative functional outcomes were reported in 57.6% of patients, finding that most had tactile sensation (93.9%) and can void while standing (92.2%). Aesthetic outcomes were only reported in 6.3% of patients, with mean length achieved being 12.26 cm (SD=0.81 cm) and mean circumference being 10.18 cm (SD=3.69 cm). In the transmasculine transgender population, current evidence of the various phalloplasty surgical techniques and their expected postoperative outcomes is weak. Future research may consider developing a standardized core outcome set to improve clinical decision making. Wang AMQ, Tsang V, Mankowski P, etal. Outcomes Following Gender Affirming Phalloplasty: A Systematic Review and Meta-Analysis. Sex Med Rev 2022;10:499-512.

Comparative Study of Monopolar and Bipolar Transurethral Resection in Patients with Benign Prostatic Adenoma

A prospective controlled study at Al-Diwaniya Urological center was compared two procedures (M-TURP and B-TURP-PLASMA ADGE). A total of 120 men were included in our study for 2 years. In 60 men with M-TURP, their age ranged from 49-89 years, size of prostate /mL ranged from 35 to 90, IPSS ranged from 8 to 34, and their SPSA ranged from 0.1–3.4 ng/mL. In the other 60 men with B-TURP (plasma edge), their ages ranged from 47 to 89 years, the size of prostate/ml ranged from 36 to 90, IPSS ranged from 9 to 34, and their S.PSA were ranged from 0.1 to 3.8 ng/mL. There was no significant difference in mean age, mean prostate size, mean IPSS, mean serum PSA, mean maximum flow rate (Q max), mean residual volume, mean hemoglobin (Hb), mean serum sodium, mean serum potassium, mean serum chloride and, mean serum creatinine (p &gt; 0.05). There was a significant difference in the mean duration of operation between the monopolar group and plasma edge group (p = 0.019), in such a way that the duration is less in the plasma edge group, 56.75 ± 9.02 minutes versus 53.10 ± 7.73 minutes. The intra-operative level of Hb was significantly higher in a monopolar group than in the plasma edge group, 13.87 ± 1.87 g/dL versus 15.06 ± 1.28 g/dL, respectively (p is less than 0.001). There was no significant difference in intra-operative mean serum sodium, potassium, chloride, and creatinine between both groups (p &gt; 0.05). The mean duration of hospital admission was more in the monopolar group compared with the plasma edge group, 1.57 ± 0.83 days versus 1.03 ± 0.18 days, respectively, in a highly significant manner (p is less than 0.001). Mean Hb level was significantly lower in the monopolar group compared to the plasma edge group, 14.00 ± 1.64 g/dL versus 15.03 ± 1.26 g/dL, respectively (p is less than 0.001). Mean IPSS was significantly lower in the monopolar group compared to the plasma edge group, 26.18 ± 4.12 versus 28.05 ± 4.09, respectively (p = 0.014). Maximum flow rate (Q max) was significantly more in the monopolar group in comparison to the plasma edge group, 16.62 ± 1.89 versus 15.03 ± 2.20, respectively (p is less than 0.001). There was no significant difference in the rate of urethral stricture between the monopolar group and plasma edge group, 1 (1.7%) versus 1 (1.7%), respectively (p = 1.000). In addition, there was no significant difference in the rate of repetition of TURP between the monopolar group and plasma edge group, 1 (1.7%) versus 1 (1.7%), respectively (p = 1.000). Our study showed that there was a shorter duration of the procedure, less bleeding, shorter duration of admission, and improvement in IPSS and Qmax.

Urethral Stricture Formation Following Cuff Erosion of AMS Artificial Urinary Sphincter Devices: Implication for a Less Invasive Explantation Approach.

ObjectivesThe objective of this study is to describe a standardized less invasive approach in patients with artificial urinary sphincter (AUS) explantation due to cuff erosion and analyze success and urethral stricture rates out of a prospective database. Evidence regarding complication management is sparse with heterogenous results revealing high risk of urethral stricture formation despite simultaneous urethroplasty in case of AUS explantation.Patients and MethodsData of all patients undergoing AUS implantation due to stress urinary incontinence (SUI) in our tertiary center were prospectively collected from 2009 to 2015. In case of cuff erosion, AUS explantation was carried out in an institutional standardized strategy without urethroplasty, urethral preparation or mobilization nor urethrorrhaphy. Transurethral and suprapubic catheters were inserted for 3 weeks followed by radiography of the urethra. Further follow-up (FU) consisted of pad test, uroflowmetry, postvoiding residual urine (PVR), and radiography. Primary endpoint was urethral stricture rate.ResultsOut of 235 patients after AUS implantation, 24 (10.2%) experienced cuff erosion with consecutive explantation and were available for analysis. Within a median FU of 18.7 months after AUS explantation, 2 patients (8.3%) developed a urethral stricture. The remaining 22 patients showed a median Qmax of 17 ml/s without suspicion of urethral stricture. Median time to reimplantation was 4 months (IQR 3-4).ConclusionWe observed a considerably low stricture formation and could not prove an indication for primary urethroplasty nor delay in salvage SUI treatment possibilities. Therefore, the presented standardized less invasive explantation strategy with consequent urinary diversion seems to be safe and effective and might be recommended in case of AUS cuff erosion.

Factors predicting the development of urethral stricture after bipolar transurethral resection of the prostate.

We aimed to investigate the rate of urethral stricture development, predictor factors, and the reliability following bipolar transurethral resection of the prostate. A total of 124 patients participated in this study. Patient data were retrospectively reviewed. The patients were divided into group 1 (those who developed urethral stricture) and group 2 (those who did not develop urethral stricture). Annual checkups were performed after the postoperative months 1 and 6. The patients were checked by uroflowmetry + post-voiding residue and international index of erectile function. We evaluated the complications that developed during the perioperative period according to the Clavien system. Urethral stricture developed in 10.5% (13/124) of the patients. It was found that patients who underwent transurethral resection of the prostate for the second time (p=0.007), patients with a preoperative catheter or history of catheter insertion (p=0.009), patients with high preoperative median white blood cell (103) counts (p=0.013), and patients with long postoperative catheterization time had a higher rate of urethral stricture after bipolar transurethral resection of the prostate (p=0.046). No grade 4 and grade 5 complications were observed according to the Clavien system in patients. Factors such as second transurethral resection of the prostate surgery, history of preoperative catheter insertion, high postoperative white blood cell count, and long postoperative catheterization time increase the risk of urethral stricture after bipolar transurethral resection of the prostate.

Management of urethral strictures after masculinizing genital surgery in transgender men

Transgender men undergoing phalloplasty and metoidioplasty have a high rate of urethral stricture. Evaluation of stricture includes evaluation of symptoms and uroflow, cystoscopy, and retrograde urethrogram. Important anatomic differences between the phallus of cis-gender and transgender men increase the likelihood and complexity of treating urethral strictures in transgender men after surgery. Urethral strictures after masculinizing procedures are more likely to require open surgical treatment and recur after treatment. There is a paucity of data, but less invasive options such as dilation and urethrotomy have had minimal success. Open surgical options with a variety of techniques, including one-stage and two-stage techniques, have higher success rates in treating strictures, but there is minimal comparative data on outcomes. We present a review on management options for urethral reconstruction in transgender men and our data on urethroplasty for these patients.

Holmium laser enucleation versus bipolar resection in the management of large-volume benign prostatic hyperplasia: A randomized controlled trial.

To compare the mid-term safety and efficacy of holmium laser enucleation of the prostate versus bipolar transurethral resection of the prostate in the management of large-volume benign prostatic hyperplasia. From December 2016 to March 2018, patients with benign prostatic hyperplasia (≥80 cc) were randomized (block randomization, computer-generated random list) to holmium laser enucleation of the prostate (57 patients) or bipolar transurethral resection of the prostate (55 patients). Patients were excluded if they had an International Prostate Symptom Score <13, a maximum urinary flow rate >15 mL/s or presence of prostate cancer, bladder stone, urethral stricture, neurogenic bladder, or previous prostate surgery. The primary outcome was hemoglobin loss. The analysis was intention-to-treat. Postoperative findings (36 months) were compared to baseline characteristics. Univariate and logistic regression analyses were performed for risk factors predicting hemoglobin loss or operative time in all patients. There was no significant difference in baseline characteristics between the two groups. Holmium laser enucleation of the prostate was associated with significantly better operative time (P = 0.019), operative efficiency (P < 0.001), hemoglobin loss (P < 0.001), catheterization duration (P < 0.001) and hospital stay (P < 0.001) compared to bipolar transurethral resection of prostate. Both procedures were safe, with no significant difference in total complications (P = 0.128). Blood transfusion (P = 0.026) and capsular perforation (P = 0.239) were reported only in the bipolar transurethral resection of the prostate group. There was no significant difference in rates of urinary tract infections (P = 0.714), urethral strictures (P = 0.359), or transient stress incontinence (P = 0.717). At the last follow-up (3 years), holmium laser enucleation of the prostate was associated with significantly better International Prostate Symptom Scores, prostate-specific antigen levels and maximum urinary flow rates compared to bipolar transurethral resection of the prostate (P < 0.05). In logistic regression analyses, prostate size and bipolar transurethral resection of the prostate were associated with significantly greater hemoglobin loss, whereas prostate size, capsular perforation, and bipolar transurethral resection of the prostate were associated with significantly longer operative time. Holmium laser enucleation of the prostate and bipolar transurethral resection of the prostate are effective and safe for the management of moderate-to-severe lower urinary tract symptoms attributable to large-volume benign prostatic hyperplasia (≥80 cc). However, if both techniques are available, holmium laser enucleation of the prostate is preferred due its better efficacy and safety profile.

Adults with previous hypospadias surgery during childhood: Beware of bulbar strictures

Urethral strictures represent the most frequent long-term complication in men after history of hypospadias surgery. To better define the spectrum of men previously treated for hypospadias during childhood, presenting at an adult urology clinic with persistent urethral complications. Retrospective review of the records of 42 consecutive adult patients with a personal history of hypospadias repair during childhood referred at one adult tertiary urology center between 2004 and 2017. Those with persistent urethral strictures were included: 28 patients (median age 28yr [17-81]). Residual chordee, aesthetic concerns, isolated fistulas, and motives of consultation unrelated to hypospadias were excluded. Early initial success rate and location of urethral stricture were studied. Statistical Analysis was done by non-parametric tests. On the 42 consecutive adults eligible, a total of 28 patients had a persistent urethral stricture. During childhood, 13/28 boys had required multiple surgical revision procedures, including six of them for postoperative urethral strictures. During adulthood, initial urethral assessment revealed 29 urethral strictures in 28 patients (penile urethra 23/29, bulbar urethra 8/29). The early initial success rate of stricture treatment was 50% (median follow-up: 4 years [1-7]). Additional surgical procedures were needed and performed in 11 patients. Eight patients were eventually diagnosed with a bulbar stricture, either isolated (n=5) or combined with a distal stricture (n=3), without significant relationship with initial position of meatus. Predictive factors for bulbar strictures locations could not be identified. It was however observed that symptomatic bulbar strictures do exist in adults, in the long term after penile hypospadias repair during childhood, independently of the initial site of hypospadias, initial success of primary repair, and the type of surgical reconstructions performed during childhood. Bulbar strictures represent more than 25% of the overall strictures diagnosed in adult patients treated for hypospadias during childhood, independently of the original site of urethral reconstruction.

PD18-03 SAFETY AND EFFICACY OF OUTPATIENT SURGICAL PROCEDURES FOR THE TREATMENT OF BENIGN PROSTATIC ENLARGEMENT IN NEW YORK STATE AND CALIFORNIA (2005-2016)

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-03 SAFETY AND EFFICACY OF OUTPATIENT SURGICAL PROCEDURES FOR THE TREATMENT OF BENIGN PROSTATIC ENLARGEMENT IN NEW YORK STATE AND CALIFORNIA (2005-2016) Michelina Stoddard, Xinyan Zheng, Jialin Mao, Alexis Te, Art Sedrakyan, and Bilal Chughtai Michelina StoddardMichelina Stoddard More articles by this author , Xinyan ZhengXinyan Zheng More articles by this author , Jialin MaoJialin Mao More articles by this author , Alexis TeAlexis Te More articles by this author , Art SedrakyanArt Sedrakyan More articles by this author , and Bilal ChughtaiBilal Chughtai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transurethral prostatectomy (TURP) and Laser prostatectomy (Laser) have become the gold standard for treatment of benign prostate enlargement (BPE). Randomized controlled trials comparing the safety and efficacy of TURP versus Laser have shown that Laser was non-inferior to TURP with similar short-term durability. However, these studies were performed in high volume centers with expert surgeons and may not represent real-world outcomes. To understand the outcomes of TURP versus Laser in a generalized population, we sought to determine the short- and long-term safety and efficacy of TURP versus Laser in the outpatient setting using real-world data from two large states in the US. METHODS: We present a prospectively collected observational cohort study of 85,682 men with benign prostatic enlargement in New York State and California who received transurethral prostatectomy or laser prostatectomy in outpatient and ambulatory surgery settings from January 2005 to December 2016. We used propensity score matching to adjust for differences in patient characteristics between groups. We analyzed short-term outcomes using mixed-effect logistic regressions and long-term outcomes using Cox regressions with a time-dependent treatment variable to account for non-proportionality. We performed a sensitivity analysis using multivariable regression models. RESULTS: Patients were aged 70.5±9.7 years (mean±SD) and mostly of white race (71%) with a median follow-up period of 3.8 (interquartile range 1.8—6.3) years. Relative to Laser recipients, TURP recipients had increased risks of 30-day hospital readmission/emergency room visit (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.04—1.13, p<0.001); 90-day risks of urinary retention (OR 1.45, CI 1.28—1.65, p<0.001), and hematuria (OR 1.56, CI 1.29—1.89, p<0.001); and higher rate of urethral stricture within 6 months of the index procedure (hazard ratio (HR) 1.47, CI 1.22—1.75, p<0.001). There was no significant difference in the risk of UTI 90 days after the index procedure (OR 0.97, CI 0.85—1.11, p>0.05), and decreased long-term risk of reoperation (HR 0.81, CI 0.76—0.88, p<0.001). CONCLUSIONS: TURP was associated with higher risk of short- and long-term complications, but a lower rate of long-term reoperation than Laser for BPE. Therefore, TURP may be more suitable for patients who are willing and/or able to tolerate more complications at the trade-off of lower risk of reoperation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e356-e356 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelina Stoddard More articles by this author Xinyan Zheng More articles by this author Jialin Mao More articles by this author Alexis Te More articles by this author Art Sedrakyan More articles by this author Bilal Chughtai More articles by this author Expand All Advertisement Loading ...

Safety and Efficacy of Outpatient Surgical Procedures for the Treatment of Benign Prostatic Enlargement in New York State and California (2005-2016).

We compared outcomes of transurethral prostatectomy and laser prostatectomy in a real-world setting. We present a prospectively collected observational cohort study of 85,682 men with benign prostatic enlargement in New York State and California who received transurethral prostatectomy or laser prostatectomy in outpatient and ambulatory surgery settings from January 2005 to December 2016. We used propensity score matching to adjust for differences in patient characteristics between groups. We analyzed short-term outcomes using mixed-effect logistic regressions and long-term outcomes using Cox regressions with a time-dependent treatment variable to account for nonproportionality. We performed a sensitivity analysis using multivariable regression models. Mean±SD patient age was 70.5±9.7 years, 71% of patients were White, and median followup was 3.8 years (IQR 1.8-6.3). Transurethral prostatectomy recipients had increased risk of 30-day hospital readmission/emergency room visit (OR 1.09, 95% CI 1.04-1.13, p <0.001) and decreased risk of reoperation (HR 0.81, 95% CI 0.76-0.88, p <0.001). Transurethral prostatectomy had a higher rate of urethral stricture (HR 1.47, 95% CI 1.22-1.75, p <0.001). Transurethral prostatectomy was associated with higher risk of short and long-term complications but a lower rate of long-term reoperation than laser prostatectomy for benign prostatic enlargement.

Stricture of Urethra: Patterns and Outcomes of Management from a Single Centre in Pakistan Over 7 Years.

To determine the outcomes of urethroplasty and its complications from a large cohort of patients managed in a single centre. Descriptive study. Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, from January 2010 to December 2016. A total of 546 patients with stricture urethra at different locations underwent urethroplasty from January 2010 to December 2016 were included. All patients had an ascending urethrogram followed by retrograde ± antegrade urethroscopy to assess the location and length of the stricture. Technique of urethroplasty was chosen according to the site, length and etiology. Following appropriate procedure, patients were followed up in the dedicated urethral stricture clinic. Procedure was considered successful if either no further therapeutic intervention was required and the maximum flow rate (Qmax) was >20 ml/sec with a voided volume of at least 200 mls. The procedure was regarded as unsuccessful, if further treatment was required or Qmax was <10ml/sec. A total of 546 patients with mean age of 32.3 +13.1 years (range: 12-74) involving anterior (n=323, 59.2%) or posterior (n=223, 40.8%) urethra were treated. Mean follow-up was 43.6 months (range: 3-84). The success rates of bulbar urethral strictures after excision and primary anastomosis (EPA) was 93. 3%, non-transecting urethroplasty 84.6% and oral mucosal graft (OMG), 81.8%. In penile urethral strictures, OMG, Orandi procedure and Johanson's techniques yielded success rates of 88.4%, 66.6% and 57.1%, respectively. In posterior urethral strictures, after excision and bulboprostatic anastomosis, good results were seen in 88.3%. In pan-urethral strictures, abdominal skin graft repair, combined tissue transfer and OMG urethroplasty yielded success rates of 74%, 78.5% and 75%, respectively. The complications/ adverse events were encountered in 251 / 546 (45.9%) patients in this series. Anastomotic urethroplasty yielded best outcomes followed by OMG urethroplasty. In the long-term follow-up, erectile dysfunction (ED), infertility and recurrence of stricture are the main complications which need individualised management.

Post-Operative Urethral Stricture after Holmium Laser Enucleation of the Prostate

Holmium laser enucleation of the prostate (HoLEP) is a safe and effective surgical procedure for patients suffering from comparatively larger benign prostatic hyperplasia. However, the rate of postoperative urethral stricture (POUS) is relatively high, which can render further invasive intervention. Here we assessed the POUS rate, riskfactors and outcomes in 206 patients with benign prostatic hyperplasia who underwent HoLEP at our hospital between January 2006 and December 2015. POUS was observed in 24 patients (11.7%). The rate of intraoperative urethral stricture was significantly higher in the patients with POUS (8 out of 24 patients, 33.3%) than in those without POUS (12 out of 186 patients, 6.6%). The odds ratio was 7.08, 95% and combination index (CI) was 2.53-19.9, p<0.001). The relative riskfor POUS based on intraoperative urethral stricture was 4.65 (95% CI : 2.28-9.48). The most common POUS site was external urethral orifice (12 out of 24 cases). The POUS onset was significantly earlier in patients with external urethral orifice than the other sites (p=0.0389). The site of postoperative stricture concurred with that of intraoperative stricture at a high rate (7 out of 8 patients). Significant differences were observed between patients with and without POUS within one month in international prostate symptom score, quality of life score and in Qmax after the operation, while they were improved by simple interventions such as bougie. In conclusion, we should consider the possibility of POUS when the patient had an intraoperative stricture in HoLEP.