Treatment Of Urethral Strictures Research Articles

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

Long-Term Outcomes of Recurrent Bulbar Urethral Stricture Treatment With the Optilume Drug-Coated Balloon: Five-Year Results From the ROBUST I Study.

We report the 5-year study closeout results for the ROBUST I trial evaluating the safety and efficacy of the Optilume drug-coated balloon (DCB) for men with short, recurrent bulbar urethral strictures. Adult men with recurrent bulbar urethral strictures ≤ 2 cm long and lumen < 12F were included in the study and treated with the Optilume DCB. Outcome measures included symptom questionnaires, maximum urinary flow rate, postvoid residual, and freedom from repeat intervention. Functional success was defined as improvement in International Prostate Symptom Score ≥ 50% without re-treatment. Fifty-three men were enrolled and treated, and 31 subjects completed all follow-up. Functional success was achieved in 58% (25/43) patients at 5 years. Average International Prostate Symptom Score improved from a mean of 25.2 at baseline to 7.2 at 5 years (P < .001). Freedom from repeat intervention was maintained through 5 years at 71.7% estimated by Kaplan-Meier. Maximum urinary flow rate improved from 5.0 mL/s at baseline to 19.9 (P < .01), and average postvoid residual was reduced from 141.4 mL to 59.5 mL (P < .01) at 5 years of follow-up. Erectile function remained unaffected. There were no serious treatment-related adverse events. In this challenging cohort of men with failed prior endoscopic treatment, the Optilume DCB shows sustained improvement in subjective and objective voiding parameters at 5 years. Optilume is a safe and effective treatment option for appropriately selected men with recurrent bulbar urethral stricture who wish to avoid urethroplasty. Results are in line with the ROBUST III randomized controlled trial that will continue follow-up through 5 years. : NCT03014726.

Laborie Optilume® Drug-coated balloon may lower the re-treatment rate post-intervention for challenging urethral stricture disease in long-term follow-up: A prospective cohort study.

Urethral stricture disease is a common and at times unsatisfying condition that can lead to complications severely impacting a patient's quality of life. Open urethroplasty remains the gold standard treatment; however, it is an invasive and highly specialized procedure. Strictures between 2 to 4 cm in length have been shown to recur at a rate of 50% within 12 months, a rate that typically decreases with each subsequent treatment. The Laborie Optilume drug-coated balloon (DCB) is the first of its kind developed for adjunct treatment of urethral strictures in men. The DCB initially treats the stricture through balloon dilatation and subsequently aims to prevent recurrence via the localized application of Paclitaxel. Our study assesses the safety and efficacy of the DCB in an Australian population with strictures exceeding 2 cm who have undergone at least two prior procedures for urethral stricture disease. Patients were prospectively recruited from November 2019 to September 2021. International prostate symptom score (IPSS), IPSS quality of life (QOL) and voiding parameters were collected at baseline, and again at 1, 6, 12 and 18 months. The drug coated balloon was applied by a single consultant urologist under rigid cystoscope with shallow direct vision internal urethrotomy with a cold knife prior to application of the DCB. 17 patients were recruited with an average of 7.7 prior urethral procedures for recurrent stricture disease. 76% were stricture free at 30 months follow-up. There were improvements in almost all parameters including max flow, average flow, IPSS and IPSS QOL scores at 12 and 24 months. There were no complications. The DCB is a safe and effective method at reducing the rates of recurrence for high-risk stricture disease and can delay or prevent the need for urethroplasty in what remains a very challenging cohort of patients.

Perineal Urethrostomy for Complex Urethral Strictures: Long-Term Patient-Reported Outcomes from a Reconstructive Referral Center and a Scoping Literature Review.

There is a paucity of long-term objective and patient-reported outcomes after definitive perineal urethrostomy for complex urethral strictures. Our objective is to determine comprehensive long-term success of perineal urethrostomy with our 15-year experience at a reconstructive referral center. Patients who underwent perineal urethrostomy between 2009 and 2023 were identified. A comprehensive long-term follow-up was conducted, evaluating both objective outcomes (retreatment-free survival) and subjective outcomes through the use of validated questionnaires. Additionally, to provide further context for our findings, we conducted a scoping review of all studies reporting outcomes following perineal urethrostomy. Among 76 patients, 55% had iatrogenic strictures, with 82% previously undergoing urethral interventions. At a median follow-up of 55 months, retreatment-free survival was 84%, with 16% of patients experiencing perineal urethrostomy recurrent stenosis. Patient-reported outcomes revealed a generally satisfactory voiding function (USS PROM LUTS score) and continence (ICIQ-UI SF), with median scores of 4 (range 0-24) and 0 (range 0-21), but with bimodal distributions of sexual function scores (median IIEF-EF: 3.5; median MSHQ-Ej: 21). Treatment satisfaction was very high with a median ICIQ-Satisfaction outcome score of 21 (range 0-24). The scoping review revealed varying success rates ranging from 51% to 95%, highlighting difficulties in comparison due to variable success definitions and patient case-mix. Perineal urethrostomy provides effective treatment for complex anterior urethral strictures, with high patient satisfaction, preserved continence function, and favorable voiding outcomes. It presents a viable option for older and comorbid patients, especially after thorough counseling on expected outcomes and potential risks.

Comparison of the effectiveness of various methods of surgical treatment of male urethral stricture

Comparison of the effectiveness of various methods of surgical treatment of male urethral stricture

Использование тулиевого лазера в лечении стриктуры уретры.

Introduction. The thulium laser is relatively recently used in the treatment of various urological diseases. Only a few studies report the use of thulium laser urethrotomy for urethral strictures. The purpose of this study was to evaluate the results of the use of a thulium laser for the treatment of urethral strictures. Materials and methods. A prospective, observational, uncontrolled study included 45 men with urethral stricture, aged 43 to 85 years (median, 65 years), who underwent thulium laser urethrotomy. The length of the stricture ranged from 0.5 to 2.5 cm (median 1.2 cm). A laser fiber with a length of 200 μm was used at an energy of 0.5 J and a power of 10 W. The success of the treatment was considered the absence of complaints of difficult urination in combination with a maximum urination rate of more than 15 ml/s and no or insignificant amount of residual urine (less than 50 ml). The dynamics of various parameters after surgery were assessed using the Wilcoxon test. The difference between the indicators was considered significant at p&lt;0.05. Results. Postoperative follow-up time ranged from 3 to 48 months (median 18 months). With these follow-up periods, treatment was successful in 32 (71.1%) patients. A significant improvement in the median of the following indicators for the entire group of patients after surgical treatment com- pared with preoperative data was established: maximum urination rate – from 9.2 to 21.1 ml/s (p=0.024); average urination rate – from 4.5 to 10.3 ml/s (p=0.025); residual urine volume – from 110 to 42 ml from 9.2 to 21.1 ml/s (p=0.014); indicators of the IPSS questionnaire – from 20 to 7 points (p=0.011); quality of life according to the IPSS questionnaire – from 5 to 2 points (p=0.017). There were no intraoperative complications. Of the postoperative complications, only urinary tract infection was noted in 5 (11.1%) patients. Conclusions. Thulium laser urethrotomy is a fairly safe and effective method for the treatment of short urethral strictures, regardless of the nature, etiology and localization of the cicatricial process. A small number of observations and a short period of postoperative observations in the world literature dictate the need to continue such scientific research.

Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy?

IntroductionInternal urethrotomy (IU) has been the most commonly used procedure for the treatment of urethral strictures (US) since it was described by Scahse in 1974. Although simple to perform and associated with a short recovery time, the main disadvantage is the high recurrence rate of stenosis. At present, there are no markers available for the prediction of recurrence after IU. The aim of this study was to evaluate the correlation between MHR and recurrence rates. MethodsThe data of a total of 250 male patients who underwent IU for the first time for bulbar urethral stricture less than 2cm in our hospital between January 2011 and January 2019 were retrospectively analysed. The MHR was calculated as the ratio of monocytes to HDL-C. ResultsIn all, 78 patients experienced a recurrence while the remaining 177 did not. The stricture recurrence rate was recorded as 31.2% at the 3-year follow-up. There was a statistically significant difference in stricture length and MHR (P=0.015 and 0.001 respectively). MHR was high in the recurrent group. As a result of the Chi-square test, the positive predictive values (PPV) and negative predictive values (NPV) were 65.3% and 89.7%, respectively. ROC analysis was used to determine the optimal cut-off value. The cut-off value was found to be 1.72. ConclusionIn our opinion, a high MHR may indicate the presence of immune inflammation and it can be used as a prognostic factor for stricture recurrence after IU. Level of evidence3

Clinical questions in the Japanese Urological Association's 2024 clinical practice guidelines for urethral strictures.

Transurethral procedures such as direct vision internal urethrotomy and urethral dilation have been the traditional treatments for urethral strictures. However, transurethral procedures are associated with high recurrence rates, resulting in many uncured cases and prompting major international urological societies to recommend urethroplasty as the standard treatment owing to its high success rate. In contrast, many Japanese general urologists have little doubts about treating urethral strictures with transurethral treatment. Therefore, urethral stricture treatments in Japan are not in line with those used in other countries. To address this, the Trauma, Emergency Medicine, and Reconstruction Subcommittee of the Japanese Urological Association has developed guidelines to offer standardized treatment protocols for urethral stricture, based on international evidence and tailored to Japan's medical landscape. These guidelines target patients with a clinically suspected urethral stricture and are intended for urologists and general practitioners involved in its diagnosis and treatment. Following the Minds Clinical Practice Guideline Development Manual 2020, the committee identified eight critical clinical issues and formulated eight clinical questions using the "patient, intervention, comparison, and outcome" format. A comprehensive literature search was conducted. For six clinical questions addressed by the existing guidelines or systematic reviews, the level of evidence was determined by qualitative systematic reviews. Quantitative systematic reviews and meta-analyses were performed for the two unique clinical questions. The recommendation grades were determined using the Delphi method and consensus by the committee. These guidelines will be useful to clinicians in daily practice, especially those involved in the care of urethral strictures.

Comparison Of Ventral Inlay and Dorsal Onlay Urethroplasty For Female Urethral Stricture

ObjectiveTo compare the outcomes of Ventral inlay buccal mucosal graft urethroplasty (VIBMGU) with dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for the treatment of Female urethral stricture (FUS). Material and MethodsThis study included women who underwent either VIBMGU or DOBMGU between January 2016 and June 2023. The preoperative AUA symptom scores, maximal urinary flow rate (Qmax), post-void residual volume (PVR) on ultrasonography, and length and location of the stricture were obtained from a prospectively maintained electronic database. The data obtained from the patient’s last visit was compared with the preoperative values for this study. The primary outcome was the success rate. The secondary outcomes were changes in AUA score, PVR, and Qmax. The patient's last follow-up visit was considered for the duration of the follow-up. ResultsSeventy-three patients were treated for BMGU for FUS. Forty-six patients underwent VIBMGU, and 27 patients underwent DOBMGU. The median duration of follow-up was 27.5 11.00-55.00) versus 14 (7.00-17.00) months respectively. The success rates of VIBMGU and DOBMGU were 89.13% and 88.89% respectively. There was a reduction in AUA scores and PVR and an improvement in Qmax postoperatively in both groups. The difference in the reduction in AUA scores between the VIBMGU and DOBMGU groups was statistically significant. The difference was not statistically significant in terms of reduction in PVR and improvement in Qmax between the two groups. ConclusionThe ventral inlay technique can provide equal results to the dorsal technique with the added advantage of vaginal sparing. This is the single largest series in the literature on female urethral stricture with the largest follow-up period of 90 months.

Comparison of laser versus cold knife visual internal urethrotomy in the treatment of urethral stricture (stricture length

There is still controversy regarding the safety and efficacy of cold knife visual internal urethrotomy and laser incisions for the treatment of urethral stricture. This study aims to compare the results of postoperative long-term and short-term maximum urinary flow rates (Qmax), surgical time, postoperative complications, and 1-year recurrence rates between the cold knife and laser surgery. We searched databases including Embase, PubMed, Cochrane, and Clinical Trials.gov to identify relevant literature published in English up to September 2023. We used Stata to compare various parameters. This study is registered in PROSPERO (CRD42023471634). Nine comparative experiments were conducted, involving a total of 659 participants. The laser group showed significantly better results compared to the cold knife group in terms of postoperative 12-month maximum urinary flow rate (mean differences [MD] 2.131; 95% [1.015, 3.249], P < .0001), postoperative bleeding (RR 0.277, 95% [0.079, 0.977], P = .046), and 1-year recurrence rate (RR 0.667, 95% [0.456, 0.976], P = .037). However, there were no significant differences in postoperative 6-month and 3-month Qmax, surgical time, urethral leakage complications, overall complications, and Visual Analog Scale (VAS) scores. The current study results suggest that laser urethral incision has greater advantages in the long-term (12 months), 1-year recurrence rate, and bleeding complications compared to cold knife urethral incision in the treatment of urethral stricture (<2 cm). Therefore, laser urethral incision may be a better choice for patients with urethral stricture.

Shwadamstradi Ghrita Uttarbasti the Ayurvedic Treatment of Urethral Stricture

In Ayurveda, Acharya Sushrut mentioned miraculous treatment for urethral stricture or mentioned as Mutrakruccha in Ayurvedic classical texts.Which briefly means difficulty in micturition. Mutrakruccha can be correlated withUrethral stricture due to the similarity between the symptoms. Many surgical and non-surgical treatments are available in modern medical science. Still, dueto thehigh recurrence and huge financial burden on the health system, Ayurvedic treatment Uttarbasti is showing promising results in the management of Urethral Stricture.Uttarbasti is the delivery of therapeutic oil or decoction via the urethra or vaginal channel.Urethral strictures can result from inflammatory, ischemic, or traumatic processes. These processes lead to scar tissue formation; scar tissue contracts and reduces the caliber of the urethral lumen, causing resistance to the flow of urine. Urethral strictures arise from various causes and can result in a range of manifestations, from an asymptomatic presentation to severe discomfort secondary to urinary retention. Retrograde urethrogram (RUG) is the main diagnostic tool to find urethral stricture and help find the length of the stricture. There is no modernmedical-science treatment for urethral stricture disease, however, urinary tract infections (UTIs) should be adequately treated before surgical intervention. Surgical treatment of urethral stricture disease is indicated when the patient has severe voiding symptoms, bladder calculi, increased postvoid residual, or urinary tract infection or when conservative management fails. Due to the high recurrence rate of surgical intervention in Urethral stricture non-invasive treatment such as Uttarbasti is always appreciated.

Comparative analysis of holmium: YAG laser internal urethrotomy versus Cold-Knife optical internal urethrotomy in the management of urethral stricture - a systematic review and meta-analysis.

Urethral stricture management has posed enduring challenges in urology, demanding innovative and effective treatment modalities. This study addresses the persistent issues associated with urethral strictures, focusing on the comparative evaluation of two contemporary treatment modalities: Ho: YAG Laser Internal Urethrotomy (HIU) and Cold Knife Optical Internal Urethrotomy (CIU). A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and ResearchGate was conducted to identify relevant studies up to November 2023. Inclusion criteria encompassed comparative studies evaluating HIU and CIU in patients with urethral stricture. Data extraction, quality assessment, and subgroup analyses were performed using standardized methods. Outcome measures included preoperative and postoperative mean the maximum urine flow rate (Qmax), mean surgical time, recurrence rates, and perioperative complications. Nine articles met the inclusion criteria, and their data were analyzed using RevMan 5.4.1. Forest plots were generated for preoperative and postoperative mean Qmax, mean surgical time, recurrence rates, and perioperative complications. While postoperative mean Qmax (MD -0.06; 95% CI: -0.28-0.16; P =0.60, I2 =75%) and mean surgical time (MD 2.16; 95% CI: -1.66-5.99; P =0.27, I2 =98%) showed no significant differences between HIU and CIU, a trend towards lower recurrence rates (RR 0.71; 95% CI: 0.48-1.06; P =0.09, I2 =46%) was observed with HIU but without statistical significance. Perioperative complications, particularly bleeding (RR 0.21; 95% CI: 0.08-0.53; P =0.001, I2 =0%), favored HIU over CIU. The subanalysis indicates that for the treatment of complex urethral strictures, the two surgical methods differ in terms of mean Qmax at 6 months postoperatively (MD -2.51; 95% CI: -4.10--0.91; P =0.002, I2 =59%) and 12 months postoperatively (MD 2.62; 95% CI: 0.93-4.30; P =0.002, I2 =0%). The HIU group shows a significant decrease in recurrence rate at 12 months postoperatively (RR 0.44; 95% CI: 0.21-0.92; P =0.03, I2 =0%). For short-segment urethral strictures with a length ≤1.5cm, CIU had a shorter operative time compared to the HIU (MD 4.49; 95% CI: 3.87-5.10; P <0.00001, I2 =44%). Overall, both interventions demonstrated similar efficacy in improving postoperative mean Qmax, mean surgical time, and recurrence rates. However, subanalysis indicates that in the short-term, CIU is more effective than HIU in improving Qmax after complex urethral stricture surgery. In long-term Qmax follow-up after surgery, HIU is significantly higher than CIU, and HIU has a low recurrence rate. In addition, for short-segment urethral stricture (≤1.5cm), CIU requires less time. In terms of complications, HIU has a lower risk of bleeding.

Анализ результатов и осложнений после повторной пластики рецидивных стриктур уретры.

Introduction. Over the past 30 years in reconstructive urology there has been a tendency to reduce the frequency of use of minimally invasive methods of surgical treatment of urethral strictures of various localizations and the predominant use of reconstructive plastic interventions with the expansion of the narrowed area of the urethra using inserts from various tissues. Buccal dilation urethroplasty is currently recognized as the optimal treatment option for urethral strictures of various locations and of varying length. Thus, the issue of choosing the most appropriate method of surgical intervention for recurrent urethral strictures, in the context of a possible increase in the risk of complications, requires additional research. Purpose. To analyze and evaluate the results and complications after plastic surgery of recurrent urethral strictures using a free autograft of the buccal mucosa. Materials and methods. The analysis included data on 51 patients operated on at the Research Institute of Urology and Interventional Radiology named after. N.A. Lopatkina–branch of the Federal State Budgetary Institution National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation for the period from 2014 to 2021 regarding recurrent urethral stricture. The average age of the patients was 36.2±1.6 years (from 18 to 58 years). The diagnosis of recurrent urethral stricture was confirmed by anamnesis, clinical and laboratory examination according to a standard protocol, and special examination methods (uroflowmetry, ultrasound examination of the bladder, retrograde or antegrade cystourethrography, voiding urethrography). According to indications, fibrourethrocystoscopy was performed. According to radiological research methods, the localization and extent of urethral stricture were determined. The functional state of the bladder and the severity of bladder outlet obstruction were determined by the volume of residual urine determined by ultrasound of the bladder, as well as by uroflowmetry data. Results. An analysis of the results and complications after plastic surgery of recurrent urethral strictures using a buccal flap was carried out after repeated operations. As the length of the stricture increases, the risk of its recurrence increases significantly. The most significant factors are the location of the stricture in the penile region and its extent. No other long-term complications (newly developed urinary incontinence/erectile dysfunction) were observed in any case in the analyzed group of patients. Conclusion. Repeated operations for recurrent urethral strictures can eliminate urinary disorders with an effectiveness close to (or equal to) that of primary operations. When choosing a method of surgical treatment of recurrent strictures, both the extent of the stricture and its location should be taken into account. The presence of an extended stricture of the penile urethra may be a risk factor for its recurrence. Complications that develop after repeated operations in the vast majority of cases are not life-threatening. The question of the effectiveness of different types of surgery requires additional research with the accumulation of clinical material.

Comparative Study of the Outcome of Buccal Mucosa Graft Urethroplasty and Preputial Flap Urethroplasty for Anterior Urethral Stricture: A Prospective Randomized Study.

Urethroplasty using a buccal mucosa graft (BMG) and a preputial skin flap (PSF) are two common techniques used for the treatment of anterior urethral stricture. The present study compared the efficacy of these two techniques on the basis of success rate, preservation of sexual function, and complications. This prospective, randomized, interventional study was conducted on adult male patients diagnosed with non-obliterative anterior urethral strictures of length >2 cm from August 2021 to December 2022. Pre-operative and post-operative work-up done included assessment of the International Prostate Symptom Score (IPSS), Quality of Life (QOL), International Index of Erectile Function (IIEF) Score, Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EJD), Bother score, Urethral Stricture Surgery-Patient-Related Outcome Measure (USS-PROM), and peak urinary flow rate (Qmax) for each patient. Post-operative values for each score were compared with pre-operative values. Out of 31 patients, 16 underwent BMG urethroplasty, and 15 underwent PSF urethroplasty. The most common cause of stricture in both groups was idiopathic (35.5% and 53.3%). A statistically significant increase in IIEF score was observed in the BMG group in comparison to the PSF group (P<0.0001). The mean IPPS score in USS-PROM has shown a significant drop in BMG (19.6 vs. 17.3; P = 0.020). Hemoglobin drop was significantly higher in PSF than in BMG (2.6 vs. 1.9; P = 0.011). A higher incidence of surgical site infection was reported in the PSF group than in the BMG group (46.7% vs. 12.5%). The average operative time for surgery was higher in PSF than in BMG (154.8 min vs. 145.0 min), respectively. Each group had one patient with a recurrence. Both techniques are equally good for urethral reconstruction (UR); however, improvement of sexual function is more in favor of the BMG urethroplasty group.

Simultaneous treatment of anterior urethral stricture and benign prostatic hyperplasia: primary experience overview

Introduction. Research on the treatment of patients with a combination of anterior urethral stricture and benign prostatic hyperplasia (BPH) is basically absent in the worldwide literature.Objective. To analyse the primary experience results with simultaneous treatment of anterior urethral stricture and BPH.Materials &amp; methods. The study included four patients with anterior urethral stricture and BPH, who underwent simultaneous surgical treatment including perineal / penile urethrostomy and thulium laser enucleation of the prostate. The success criterion for treatment was considered to be the absence of obstructive lower urinary tract symptoms requiring the use of endoscopic or open surgery, regardless of whether urethrostomy was considered as the first step or the final option for urinary diversion.Results. The age of the patients ranged from 54 to 69 years (mean 63.0 ± 6.5 years). In one (25%) patient the stricture was localised in the penile urethra and in three (75%) patients it was localised in the bulbous urethra. The stricture length ranged from 1.0 to 3.0 cm (mean 2.1 ± 0.9 cm). The prostate volume varied from 45 to 77 cc (mean 63.8 ± 13.5 cc). One patient had cystostomy drainage. The post-void residual volume among 3 patients with preserved urination ranged from 90 to 130 ml (mean 113.3 ± 20.8 ml). Postoperative follow-up periods ranged from 3 to 18 months (mean 11.3 ± 7.4 months). At these follow-up periods, treatment was successful in all four (100%) patients. No intra- or postoperative complications were observed.Conclusions. The proposed method can be successfully applied in patients with a combination of anterior urethral stricture and BPH. However, the final guidelines for the management of such patients can be developed after further research.

Minimal invasive treatment of urethral strictures: An experimental study of the effect of paclitaxel coated balloons in the wall of strictured rabbit's urethra.

The aim of this study is the evaluation of the distribution of paclitaxel (PTX) released by a coated balloon in the layers of rabbit's urethra. 18 rabbits were included. A laser device was used for the stricture formation. After two weeks, dilation of the strictured urethra was performed by using Advance 35LP PTA balloons and Advance 18 PTX PTA balloons. The experimental models were divided into 3 groups. The group Α included two rabbits without any intervention except for the stenosis procedure. Group B compromised six rabbits that underwent dilation with Advance 35LP PTA balloons. Group C consisted of 10 rabbits to which dilation with both Advance 35LP PTA balloons and Advance 18 PTX PTA balloons was applied. Histological evaluation and Immunohistochemistry were performed on all specimens. Inflammation, fibrosis and ruptures were detected in the specimens of the study. In specimens of Group C the decrease of inflammation and fibrosis rate was greater. Anti-PTX antibody was detected in the epithelium, lamina propria and smooth muscle layer of all specimens of urethras that have been harvested immediately and 1 day after the dilation with Advance 18 PTX PTA balloon and it was not observed in any layer of the urethral wall of the rest of the examined specimens of Group C. PTX's enrichment was detected in the smooth muscle layer of all specimens that have been harvested immediately and 24h after the dilation with Advance 18 PTX PTA balloons. PTX may play an inhibitive role in the recurrence of the stenosis.

Use and Outcomes of Amplatz Renal Dilator for Treatment of Urethral Strictures

Background: Urethral strictures pose a significant challenge in urological practice, with traditional treatments often associated with considerable morbidity. The quest for less invasive yet effective interventions has led to innovative approaches, among which the Amplatz Renal Dilator has emerged as a promising tool. Objective: This study aimed to evaluate the efficacy and safety of the Amplatz Renal Dilator in the treatment of urethral strictures, focusing on urinary flow rates, stricture severity, patient symptom relief, and the incidence of complications. Methods: A prospective, observational cohort study was conducted at multiple centers including Gajju Khan Medical College Swabi Naseer Teaching Hospital Peshawar in the duration from January, 2023 to June, 2023. Total Thirty-five participants diagnosed with urethral strictures were enrolled and treated with the Amplatz Renal Dilator. The study spanned two years, with an initial six-month recruitment phase followed by an eighteen-month follow-up. Efficacy was assessed through improvements in urinary flow rates and stricture severity, while safety was evaluated by monitoring procedural complications and recurrences. Quality of life and patient satisfaction were also measured using validated questionnaires. Results: Post-treatment, urinary flow rates significantly improved from a mean of 10 mL/s (SD ± 2) to 15 mL/s (SD ± 3) (p&lt;0.001). Stricture severity decreased from Grade 3 (SD ± 1) to Grade 1 (SD ± 1) (p&lt;0.001). International Prostate Symptom Score (IPSS) from 22 (SD ± 4) to 10 (SD ± 3) (p&lt;0.001). The incidence of immediate complications was 5%, with no significant long-term complications reported. The recurrence rate of strictures was observed at 10%. Conclusion: The Amplatz Renal Dilator demonstrates significant efficacy in improving urinary flow rates and reducing stricture severity, with minimal complications and a low recurrence rate. These findings suggest that the Amplatz Renal Dilator is a safe and effective option for the treatment of urethral strictures, warranting further investigation in larger, randomized controlled trials.

Female Urethroplasty with a Buccal Mucosa Graft using a Supraurethral Approach.

In the setting of recurrent female urethral stricture, urethroplasty offer the best chance of cure. However, which approach (dorsal or ventral) and which tissue (buccal mucosa, vaginal graft, vaginal flap) remain areas of controversy. In this article and accompanying video, we describe female urethroplasty with a supraurethral approach using a buccal mucosa graft. A stricture of 3 cm in length was observed in the mid urethra. A supraurethral semi-lunar incision was made and dissection was performed up to the stricture. A dorsal urethrotomy was performed and a 3 × 2 cm oral mucosal graft was harvested from the left cheek. The mucosal graft was anastomosed to both urethral edges with running sutures. The graft was fixed to the supraurethral tissue with quilting sutures. A urethral catheter and a suprapubic catheter were left in place for 3 weeks. Following removal of the catheters, the patient was able to void satisfactorily with no incontinence. No complications were observed in the urethral area or at the graft harvest site. Buccal mucosa graft urethroplasty with a supraurethral approach is a reliable method in the treatment of female urethral stricture.

Male sling adjustability: does it truly matter?

Patients with post prostatectomy incontinence (PPI) seem to have different needs. Therefore, device post-operative readjustability may be a beneficial feature in PPI management, even though it lacks study support. The purpose of this study is to describe our surgical technique for male sling (MS) implantation, assess outcomes, and the impact of readjustability. We performed a retrospective analysis of 89 consecutive patients who underwent PPI correction with MS Argus-T™ (Promedon, Córdoba, Argentina) from 2009 to 2021. The median follow-up was 48months (12-120). Data were collected in a dedicated database. Perioperative variables were assessed. A descriptive statistical analysis was performed. Clinical and urodynamic variables were correlated with the need for readjustments and success. In this cohort, objective success was achieved in 80.5% of the patients (65.9% cured and 14.6% improved). A total of 85.4% of the patients met the criteria for subjective success (74.4% cured and 11% improved). For the subgroup of patients who received previous treatment for urethral stricture (US), 79% achieved objective success (63.2% cured, 15.8% improved), and 84.2% achieved subjective success (78.9% cured, 5.3% improved). For the subgroup of patients who received previous radiotherapy (RT) before sling surgery, 68.7% achieved objective success (37.5% cured, 31.2% improved), and 75% achieved subjective success (37.5% cured, 37.5% improved). Procedures for device readjustment were necessary for 27.7% of patients in the total study population. RT and previous US treatment were predictive factors for the need of readjustment, with rates of 66.7% and 61.1% (OR: 8.46; CI: 2.46-29.00; p = 0.001/OR: 6.41; CI: 2.05-20.03; p = 0.001, respectively). MS adjustability improved success rates, especially among irradiated patients and those with previous US. RT was an adverse predictor of total continence status even after readjustments.

Balloon dilation for the treatment of male urethral strictures: a systematic review and meta-analysis

ObjectiveThe use of minimally invasive endoluminal treatment for urethral strictures has been a subject for debate for several decades. The aim of this study was to review and discuss the...