Treatment Of Urethral Strictures Research Articles

Emergency tactics for the treatment of urethral strictures caused by scleroatrophic lichen

Emergency tactics for the treatment of urethral strictures caused by scleroatrophic lichen

Effect of local steroids on urethral strictures: A systematic review and meta-analysis.

PurposeUrethral stricture disease is common and has high associated morbidity and impact on quality-of-life. This systematic review and meta-analysis aims to summarise current evidence on the efficacy of local urethral steroids post-direct vision internal urethrotomy (DVIU) for the treatment of urethral strictures in males.Materials and MethodsA comprehensive search was performed using reputable databases and registries, up to 22 February 2022. Only randomised control trials in which participants were randomised to DVIU plus local urethral steroids versus DVIU only were included. Statistical analyses were performed using a random-effects model. Quality of evidence was rated according to the GRADE approach.ResultsThe search identified seven studies in which 365 participants were randomised to DVIU plus local urethral steroids versus DVIU only. The application of local steroids appeared to reduce recurrence rates (risk ratio, 0.67; 95% confidence interval [CI], 0.49–0.90) and time-to-recurrence (hazard ratio, 0.58; 95% CI, 0.39–0.85). Qmax also improved following steroid application (mean difference, 0.82; 95% CI, -1.02–2.66); however, this was not statistically significant. No heterogeneity was identified between included studies for all outcomes. The certainty of evidence was downgraded due to study limitations with a small sample size and unclear risk-of-bias related to insufficient trial information.ConclusionsCompared to DVIU alone, adjuvant steroids applied to the urethra may reduce risk of recurrence and time-to-recurrence. These findings were statistically significant and likely also clinically significant given low associated costs and risk. However, more robust randomised trials are necessary to enhance the validity of these outcomes.

Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men

BackgroundSeveral treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the surgical outcomes. AimThe aim of this study was to analyze the surgical outcomes after treatment of urethral strictures and urethral fistulas following metoidioplasty. MethodsA multicenter retrospective cohort study was conducted with transmen treated for strictures and fistulas after metoidioplasty in 3 tertiary referral centers. OutcomesThe primary outcome was the recurrence-free rate after surgical treatment of urethral strictures and urethral fistulas over a time period of 3 years postoperatively. ResultsOf 96 transmen included in this study with a urethral complication, 44 (46%) experienced a urethral fistula, 31 (32%) a urethral stricture, and 21 (22%) both complications simultaneously. The recurrence-free rate for urethral strictures following endoscopic management (ie, urethral dilation or direct visual internal urethrotomy) was 61% after 1, 50% after 2, and 43% after 3 years, compared to 82% following open treatment options after 1, 2, and 3 years (P = .002). Open treatment options were Heineke-Mikulicz procedure (7/9, 78% success), excision and primary anastomosis (3/3, 100%), 2-stage without graft (9/9, 100%), pedicled flap urethroplasty (1/1, 100%), and buccal mucosa graft urethroplasty (2/4 [50%] single-stage, 1/1 [100%] 2-stage). The recurrence-free rate for small urethral fistulas located at the pendulous urethra was 79% after 1, and 72% after 2 and 3 years, compared to 45% after 1, and 41% after 2 and 3 years for large fistulas, generally located at the urethral anastomoses of the fixed urethra. Treatment options for urethral fistulas were fistulectomy (26/48, 54%), fistulectomy & (redo) colpectomy (7/11, 64%), buccal mucosa graft urethroplasty (1/1, 100%), and retubularization of the urethral plate (3/4, 75%). A colpectomy before or during reoperation of a urethral fistula at the proximal urethral anastomosis showed higher success rates compared to without a colpectomy (7/11 [64%] vs 2/13 [15%] respectively, P = .03). Clinical ImplicationsThis study provides insight in the treatment possibilities and corresponding outcomes of urethral complications following metoidioplasty in transmen. Strengths & LimitationsStrengths were the relatively large sample size and the overview of multiple treatment options available. Limitations were the heterogeneity of the cohort, underexposure of some surgical modalities, and absence of patient-reported outcomes. ConclusionOpen surgical techniques show better long-term outcomes in the management of urethral strictures compared to endoscopic options, and a colpectomy is beneficial before or during urethral fistula repair at the proximal urethral anastomosis.de Rooij FPW, Falcone M, Waterschoot M, et al. Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men. J Sex Med 2022;19:377–384.

Промежностная и пенильная уретростомии: хирургический результат и оценка рисков осложнений

Urethral repair in the complex urethral strictures (US) is associated with a high risk of failure. In some cases, urethrostomy is justified when choosing a method of treatment for this category of patients.To assess the results of perineal and penile urethrostomy and identify factors associated with the development of early surgical complications and urethrostomy stenosis (USs).85 patients aged 53.9 years underwent urethrostomy from 2010 to 2019: permanent - 48 (56.5%), due to refusal of urethroplasty - 37 (43.5%). Penile urethrostomy was formed in 41 (48.2%) patients, perineal USs - in 44 (51.8%), respectively. The US etiology was as follows: inflammatory - 32.9%, iatrogenic - 29.4%, idiopathic - 28.2%, traumatic - 9.4%. The US length was 6 cm or more in 58.8% patients, multifocal lesions occurred in 22.4% cases, subtotal - in 28.2%. The criterion for successful treatment was the absence of complications requiring repeated surgery on the urethra and / or systemic bougienage (median follow-up - 58 mo). The contribution of various factors to the increased risk of developing USs was assessed using univariate analysis by calculating the odds-ratio (OR, 95% CI). Statistical significance was tested using the 2 test, Fishers test. Multivariate analysis was performed using logistic regression.Early postoperative complications (EPCs) were detected in 7 (8.2%) patients [urethritis (2), wound phlegmon (2), scrotal hematomas (1), unrecovered urination (1), acute urinary retention (1)]. Of these, only 2 (2.4%) cases required additional surgical intervention. USs was detected in 14 (16.5%) patients during the follow-up period from 3 to 200 mo (median - 8 mo). USs surgical correction was required in 12 (14.1%) cases, systemic bougienage - in 2 (2.4%) cases. Independent risk factors for all complications were UTIs (OR=3.3; 95% CI - confidence interval (CI)=1,17 - 9,1; p=0.013), arterial hypertension (OR=2.3; 95% CI=1.02 - 5.05; p=0.044), bougienage (OR=2.4; 95% CI=1.08 - 5.33; p=0.031), the US multifocal localization (OR=2.8; 95% CI=1.28 - 6.05; p=0.011), and for stenoses, in particular, UTIs (OR=6.1; 95% CI=1.45 - 25.22; p=0.003), arterial hypertension (OR=2.6; 95% CI=1.05 - 6.40; p=0.035), previous hypospadias repair (OR=3.3; 95% CI=1.27 - 8.55; p=0.031) and EPCs (OR=4.1; 95% CI=1.74 - 9.41; p=0.004). The combination of unfavorable factors identified in multivariate analysis determines development from 21.8% to 49.9% cases of early and late complications.Urethrostomy may be the ultimate treatment for spongy complex US with an 82.4% primary success rate. The main factors negatively affecting the surgery outcomes are arterial hypertension, chronic kidney disease, US multifocal localization, previous bougienage, previous hypospadias repair, urethrocutaneous fistulas and EPCs.

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China.

Background: Male urethral stricture is a disease with a high incidence rate. With social-economic development in the developing countries, the trend of etiology and treatment of male urethral stricture changed was speculated.Methods: The clinical data of the male patients with urethral stricture from 2000 to 2019 were analyzed. The subjects were divided into Group A (2000–2009) and Group B (2010–2019) according to treatment time. The pooled analysis of the data extracted from pieces of literature was also performed.Results: About 540 patients were included in the present study, including 235 patients in Group A and 305 patients in Group B. In recent 10 years, trauma has still been the main cause of urethral stricture. Iatrogenic injury, especially transurethral operation, increases significantly, while male urethral stricture secondary to radiotherapy and infection decrease. Urethroplasty increases and the reoperation rate decreases in treating simple urethral stricture, and flap urethroplasty also increases in treating complex urethral stricture. The results of a pooled analysis of data from 11 centers in Mainland China are partially consistent with it. Complications, such as urethral fistula, false canal, ejaculation disorder, and penile curvature, decrease significantly.Conclusions: The main causes of urethral stricture in the recent 10 years are still trauma and iatrogenic injuries, and the etiology of urethral stricture is related to socioeconomic development. With the increase of intracavitary minimally invasive treatment and flap urethroplasty, the curative effect is increasing, while iatrogenic urethral stricture cannot be ignored.

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume® Drug-Coated Balloon for Anterior Urethral Strictures.

The Optilume® drug-coated balloon (DCB) is a urethral dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. The ROBUST III study is a randomized, single-blind trial evaluating the safety and efficacy of the Optilume DCB against endoscopic management of recurrent anterior urethral strictures. Eligible patients were adult males with anterior strictures ≤12Fr in diameter and ≤3 cm in length, at least 2 prior endoscopic treatments, International Prostate Symptom Score ≥11 and maximum flow rate <15 ml per second. A total of 127 subjects were enrolled at 22 sites. The primary study end point was anatomical success (≥14Fr by cystoscopy or calibration) at 6 months. Key secondary end points included freedom from repeat treatment, International Prostatic Symptom Score and peak flow rate. The primary safety end point included freedom from serious device- or procedure-related complications. Baseline characteristics were similar between groups, with subjects having an average of 3.6 prior treatments and average length of 1.7 cm. Anatomical success for Optilume DCB was significantly higher than control at 6 months (75% vs 27%, p <0.001). Freedom from repeat intervention was significantly higher in the Optilume DCB arm. Immediate symptom and urinary flow rate improvement was significant in both groups, with the benefit being more durable in the Optilume DCB group. The most frequent adverse events included urinary tract infection, post-procedural hematuria and dysuria. The results of this randomized controlled trial support that Optilume is safe and superior to standard direct vision internal urethrotomy/dilation for the treatment of recurrent anterior urethral strictures <3 cm in length. The Optilume DCB may serve as an important alternative for men who have had an unsuccessful direct vision internal urethrotomy/dilation but want to avoid or delay urethroplasty.

Diagnosis and treatment of anterior urethral strictures in China: an internet-based survey

BackgroundTo investigate the current diagnostic and therapeutic approaches to anterior urethral strictures of Chinese urologists and to compare with developed countries and the American Urologic Association guidelines.MethodsAnonymous questionnaires were distributed to members of Official Wechat Account of urology from March 19, 2020 to April 10, 2020. Descriptive and multiple correspondence analysis were used to analyze the data.ResultsA total of 1276 online questionnaires were received. The response rate was 21.7% (1276/5878). The most common diagnostic methods for anterior urethral stricture were urethrography (90.7%) and urethrocystoscopy (85.4%), while urethral dilation (92.3%) and internal urethrotomy (60.1%) were the main therapeutic procedures. End-to-end urethroplasty (45.2%) was the most common open surgery, followed by skin flap urethroplasty (14.9%) and free graft urethroplasty (12.4%). 76.2% of urologists used urethroplasty only after the failure of minimally invasive surgery (reconstructive ladder treatment strategy). Furthermore, middle-aged or elderly urologists who had attended trainings, had senior practice roles, and who utilized a reconstructive ladder treatment approach were most likely to perform urethroplasties.ConclusionsAnterior urethral stricture treatment in China is still dominated by minimally invasive surgery, with most urologists using the reconstructive ladder treatment strategy. In general, the overall diagnostic and therapeutic strategies were similar between China and developed countries, with some deviations from the American Urologic Association guidelines.

Buccal mucosal graft urethroplasty for anterior urethral stricture, experience from a low-income country

Background/purposeThis study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, as the first experience in our context.MethodsThis is a prospective hospital-based study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from January 2017 to January 2019.ResultsThe total number of involved patients was 60. The success rate was found to be 90% (n = 54), while 6 (10%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 50 (83.3%) and 2 (3.3%) patients, respectively. late complications occurred as follows 14 (23.3%) patients had UTI, 12 (20%) had wound infections, 8 (13.3%) had changes in ejaculation, and decrease in intensity of orgasm, and 6 (10%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG).ConclusionImprovement of the service in limited resources countries like Sudan and was reflected in the excellent outcome of BMG urethroplasty as treatment of anterior urethral stricture (success rate 90%).

Substitution Buccal Mucosal Graft Urethroplasty for Long Segment Anterior Urethral Stricture : Our Experience in Dorsolateral Onlay Approach

Background: Currently the most favorable single stage procedure for management of long segment anterior urethral stricture is dorsal onlay technique of urethroplasty. This required circumferential extensive mobilization of the urethra, which might cause ischemia of urethra in addition to chordee. To evaluate the short term outcome of dorsolateral onlay BMG (Buccal Mucosal Graft) urethroplasty by unilateral urethral mobilization for treatment of long segment anterior urethral stricture&#x0D; Materials and methods: A prospective experimental study from January 2016 to December 2018 is carried out in Department of Urology, Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh. Total 32 patients of long segment anterior urethral stricture were treated by dorsolateral onlay BMG urethroplasty by unilateral urethral mobilization. Stricture &gt;2cm were included; RGU, MCU and Uroflowmetry were the mainstay of assessment. Success was defined as maximum flow rate &gt;15 ml/s, normal RGU and/ urethroscopy. Failure considered as presence of obstructive symptoms, Qmax &lt; 15 ml/s, stricture on RGU and any post-operative urethral intervention.&#x0D; Results: Mean stricture length was 48.72mm (Range: 30-77mm) and mean follow up time was 22.4months (Range: 12-40 months). Three patients were found to develop stricture at proximal anastomotic site during follow up and required optical internal urethrotomy and considered as failure. 01 patients developed Surgical Site Infection (SSI) which resolved after regular dressing. Success rate was 90.7%&#x0D; Conclusion: Dorsolateral onlay BMG urethroplasty by unilateral mobilization is feasible, safe and easily adoptable for long segment anterior urethral stricture with good short term outcome.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 14-17

Research progress in endoluminal treatment of urethral stricture

Urethral stricture is regarded as a common disease in urology whose treatment modalities usually include open surgery and endoluminal treatment. Endoluminal techniques have gradually become one of the essential treatments in urethral stricture due to easier operation, less trauma, faster recovery, higher safety and fewer complications. The popularity of plasma knife and laser, and the application of new urethral stents and grafts, make endoscopic surgery easier and less invasive. However, due to its anatomical particularity and diverse etiologies of urethral stricture, the endoluminal treatment is still not satisfactory and a considerable number of patients still experience poor long-term treatment effect. Non-operative managements, such as intracavitary brachytherapy, intracavitary injection of drugs or stem cells and new urinary catheters are also being explored in treating urethral stricture, which would improve the effect of endoscopic surgery. This review summarizes the clinical application and new progress of various kinds of endoluminal treatments and pharmacotherapy in urethral stricture at home and abroad. More prospective randomized controlled studies are needed to confirm its feasibility, effectiveness and optimal time of operation.

Можливості використання ендоскопічного обладнання в лікуванні коротких посттравматичних стриктур уретри в дітей

Актуальність. Пошкодження уретри при пошкодженні кісток таза в дітей відмічається рідше, ніж у дорослих (менше 1 %) (Tarman G.J. et al., 2002). Посттравматична стриктура уретри в дітей є досить рідкісною та складною урологічною патологією. З урахуванням анатомічних особливостей лікування стриктури уретри в дітей відрізняється від її лікування в дорослих (Onen A. et al., 2005; Nerli R.B. et al., 2008; Ranjan P. et al., 2011). М.М. Koraitim (2012) описав досвід лікування 20 хворих з ускладненнями після трансперинеальної пластики уретри. Автор відмітив, що у разі відсутності необхідності реконструкції шийки сечового міхура достатньо ефективним є ендоскопічне розсічення стриктури уретри. Т.Е. Helmy, А.Т. Hafez (2013) теж описали результати успішного застосування ендоскопічного обладнання (пряма візуальна уретротомія) після відкритих уретропластик. Важливим моментом, що спонукає до пошуку ефективних малоінвазивних методів лікування посттравматичних стриктур уретри в дітей, є розвиток еректильної дисфункції у подальшому, що, за даними деяких авторів (Koraitim M.M., 2014), становить до 47 %. Мета дослідження: на основі доступних літературних даних і власних результатів лікування дітей із стриктурами задньої уретри установити роль ендоскопічного лікування вказаної складної патології як методу профілактики та лікування нервово-м’язової дисфункції сечового міхура. Матеріали та методи. На базі хірургічних відділень Житомирської обласної дитячої клінічної лікарні широко впроваджені малоінвазивні ендоскопічні методи діагностики та лікування патології нижніх сечових шляхів. Наявне обладнання дає можливість проводити діагностичні процедури, починаючи з місячного віку. Виконується цілий ряд ендоскопічних оперативних втручань на нижніх сечових шляхах, а саме: видалення конкрементів, розсічення клапанів та стриктур задньої уретри, розсічення кіст уретри та ектопічних уретероцеле тощо. Також у 2010 році вперше виконано спробу за допомогою черезшкірної трипортової цистоскопії видалити вклинений у рубцево-змінену задню уретру конкремент. З 2013 року розпочато лікування посттравматичних стриктур задньої уретри під ендоскопічним контролем. Результати. Подано результати успішного малоінвазивного лікування із застосуванням сучасного ендоскопічного обладнання у двох хворих із посттравматичними стриктурами задньої уретри. Особливо наголошено на ефективності методу в діагностиці та лікуванні нервово-м’язової дисфункції сечового міхура в даної категорії хворих. Висновки. Отже, застосування сучасного малоінвазивного обладнання не лише дає можливість ефективно діагностувати пошкодження нижніх сечових шляхів, а й може бути дієвим механізмом малотравматичного хірургічного лікування при коротких посттравматичних стриктурах уретри в дитячому віці. Своєчасне якісне лікування рубцевих стриктур уретри в дітей зведе до мінімуму розвиток інфравезикальної обструкції та порушення евакуаторної функції сечового міхура із розвитком його нервово-м’язової дисфункції.

Оценка эффективности оперативного лечения рецидивной стриктуры уретры

INTRODUCTION The recurrent course of the disease stricture is a complex problem for both the patient and the operating surgeon and requires an integrated approach to treatment only in expert centers. PURPOSE OF THE STUDY To assess the effectiveness of methods of surgical treatment of recurrent urethral strictures. MATERIALS AND METHODS At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, an analysis of the results of surgical treatment of patients with recurrent urethral stricture from 2012 to 2020 was carried out. This work included patients who underwent surgical treatment for recurrent urethral stricture. A total of 120 men were involved in the work. The median length of the stricture was (min-max) - 2 (0.5-16 cm). In 95 (79.1%) patients, stricture of the bulbous urethra, in 15 (12.5%) - in the penile urethra, in 2 (1.7%) patients had panurethral stricture, in 6 (5.0%) - membranous urethra and in 2 (1.7%) - meatus. All patients were divided into two groups: with recurrent urethral stricture after primary DVIU (group I, n=77) and recurrent urethral stricture after primary urethroplasty (group II, n=43). Depending on the method of surgical treatment of recurrent urethral stricture, patients in group I were divided into 4 subgroups. Repeated DVIU + 3 months Autocatheterization - 16 (20.8%) patients; End-to-end urethroplasty - 37 (48.1%) patients; one-stage urethroplasty with a buccal graft or skin graft - 22 (28.6%) patients; multistage urethroplasty or perineostomy - 2 (2.5%) patients. Group II was also divided into 4 subgroups. DVIU - 17 (39.5%) patients; end-to-end urethroplasty - 6 (13.9%) patients; one-stage urethroplasty with a buccal graft or skin graft - 9 (20.9%) patients; multistage urethroplasty - 11 (16.7%) patients. Median Qmax - 4.68 ml/sec. Preoperative cystostomy was observed in 31 (25.8%) patients. RESULTS The median follow-up was 24 months (range 12 to 76 months). Depending on the method of surgical treatment of recurrent urethral stricture, the effectiveness of DVIU according to strict indications was 75.7%. End-to-end urethroplasty showed an efficiency of -88,4%. One-stage augmentation urethroplasty had an efficiency of -77,4%, and multi-stage urethroplasty showed an efficiency of 84.6%. The IPSS value for the observation period 2 years was 2.6+/-0.9 points. The average value of Qmax at the time of observation was 19.4+/-7.1 ml/sec. The effectiveness of the treatment was 82%. During the follow-up period, a relapse was noted in 22 (18%) patients. The overall effectiveness of the treatment of recurrent urethral stricture, taking into account the treatment of recurrent cases of disease recurrence, was 97.5%. CONCLUSIONS Urethroplasty is the treatment of choice for recurrent urethral strictures, which has been shown to be more effective than DVIU. However, the results of urethroplasty for recurrent strictures are worse than for primary strictures.

MP67-19 THE IMPACT OF AN INTERNATIONAL PARTNERSHIP ON THE TREATMENT OF MEN WITH BULBAR URETHRAL STRICTURES AND PELVIC FRACTURE URETHRAL INJURIES (PFUI) IN VIETNAM

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-19 THE IMPACT OF AN INTERNATIONAL PARTNERSHIP ON THE TREATMENT OF MEN WITH BULBAR URETHRAL STRICTURES AND PELVIC FRACTURE URETHRAL INJURIES (PFUI) IN VIETNAM Hung Do, Justin DeGrado, and Joel Gelman Hung DoHung Do More articles by this author , Justin DeGradoJustin DeGrado More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In Vietnam, there is a high incidence of bulbar urethral straddle and pelvic fracture urethral injuries (PFUI) due to the prevalent use of motor bikes for transportation. Urethral strictures have historically been managed with suprapubic tubes, periodic dilation, or 1 or more attempts at urethroplasty that often fail. A United States - Vietnam outreach relationship was established to improve treatment success and decrease the societal burden of urethral stricture disease. We report the impact of this partnership METHODS: A Faculty Urologist at a major Vietnamese teaching hospital (Binh Dan Hospital in HCMC) with an interest in developing expertise in urethroplasty was identified. The Urologist travelled to the United States to receive observational exposure to urethral imaging and surgery. In addition, yearly 2-week trips were established from 2014-present. The initial focus was patient evaluation, urethral imaging (retrograde urethrogram and voiding cystourethrogram), and decision making. This included the first use of flexible cystoscopes in Vietnam. The subsequent focus was operative, mostly anastomotic urethroplasty, with the mentor-mentee. IVUmed provided 2-3 Resident Scholarships for each outreach trip. Binh Dan hospital was provided urethroplasty specific instruments and their first flexible cystoscope. An imaging and follow-up protocol was established which included 4-month cystoscopy to assess outcomes. A database was created to prospectively evaluate success rate over the 2016-2020 study period. RESULTS: Bulbar anastomotic urethroplasty was performed in 97 men. Of the 40 that returned for 4-month cystoscopy, there were 5 recurrences (success rate=87.5%). Posterior urethroplasty for PFUI was performed in 101 men. Of the 74 that returned for 4-month cystoscopy, with 32/74 of those being revision surgery, there were 4 recurrences (success rate=94.6%) with 3 of the 4 failures in re-do cases. With a mean follow-up (defined as time interval between surgery and most recent visit) of 5.0 months (bulbar) and 9.5 months (PFUI), there were no additional recurrences identified, defined as obstructive symptoms or need for intervention. CONCLUSIONS: In Vietnam, the development of an international partnership at a hospital with the necessary infrastructure has been associated with the establishment of a high success rate for bulbar and posterior urethroplasty. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e517-e517 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hung Do More articles by this author Justin DeGrado More articles by this author Joel Gelman More articles by this author Expand All Advertisement Loading ...

MP56-09 HISTOMORPHOLOGICAL ANALYSIS OF THE REGENERATIVE POTENTIAL OF PLATELET-RICH PLASMA DURING URETHROPLASTY (IN AN EXPERIMENTAL MODEL)

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-09 HISTOMORPHOLOGICAL ANALYSIS OF THE REGENERATIVE POTENTIAL OF PLATELET-RICH PLASMA DURING URETHROPLASTY (IN AN EXPERIMENTAL MODEL) Sergey Kotov, and Mikhail Iritsyan Sergey KotovSergey Kotov More articles by this author , and Mikhail IritsyanMikhail Iritsyan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstructive plastic surgery is the gold standard for the treatment of primary urethral strictures, but the effectiveness of these methods does not reach 100%. In cases of recurrent urethral strictures, the effectiveness of standard operations is lower than in primary strictures, which requires the search for methods to improve the results of surgical treatment. To evaluate changes in the structure of the intercellular matrix, the cellular composition of the spongiose body, and the regenerative potential of platelet-rich plasma after urethroplasty on a biological model. METHODS: The experiment was performed on male rabbits of the breed "Burgundy" weighing 3.0-4.5 kg (18 individuals). Two groups of animals were formed: experimental (9 individuals) and control (9 individuals). All animals in each group underwent end-to-end anastomotic plasty of the bulbous urethra according to the standard procedure. In the control group, an isotonic solution of 0.9% NaCl was injected into the spongy body in the anastomosis zone; in the experimental group, autologous plasma enriched with platelets was administered. Routine hematoxylin-eosin staining was performed to visualize the histoarchitectonics of the tissues. Van Gieson staining to identify the collagen fibers and correct their orientation. In order to detail the inflammatory and regenerative changes, an additional immunohistochemical study was performed with antibodies: CD79a, CD43, CD31 (PECAM1), MMP1, MMP9. The expression level of MMP1, MMP9 was evaluated by counting positive cells in the submucosal and muscle layers. The level of angiogenesis in micro-preparations was estimated by counting the number of vessels, and reliable endothelial imaging was performed using CD31(PECAM1) expression. RESULTS: The local application of platelet-rich plasma in the suture zone contributes to a reduction in the zone of necrotic changes and the severity of inflammation, accelerated migration of macrophage-histiocyte cells to the focus of alteration, and increased blood supply due to enhanced angiogenesis. Also, in the experimental samples, there was a higher expression of metalloproteinases (collagenases) of type 1 and 9, reduced collagen production, and correct orientation of collagen fibers during the repair processes. CONCLUSIONS: According to the results of the experiment, the use of platelet-rich plasma promotes the acceleration of reparative processes in the spongy body after urethroplasty. In clinical practice, this may reduce the duration of lower urinary tract drainage and, consequently, the risk of infectious complications. In turn, the expression of metalloproteinases and a decrease in collagen production, the correct orientation of collagen fibers can reduce the amount of pathological fibrous-scar tissue in the surgical area, which reduces the risk of recurrence of urethral stricture after surgical treatment in clinical practice. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e972-e972 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sergey Kotov More articles by this author Mikhail Iritsyan More articles by this author Expand All Advertisement Loading ...

MP67-15 INTERNATIONAL OUTREACH SURGERY WORKSHOPS CAN DOUBLE AS A FOCUSED SUB-SPECIALTY HANDS-ON TRAINING OPPORTUNITY FOR UROLOGISTS FROM OTHER COUNTRIES SEEKING TO IMPROVE THEIR SKILLS AND OUTCOMES

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-15 INTERNATIONAL OUTREACH SURGERY WORKSHOPS CAN DOUBLE AS A FOCUSED SUB-SPECIALTY HANDS-ON TRAINING OPPORTUNITY FOR UROLOGISTS FROM OTHER COUNTRIES SEEKING TO IMPROVE THEIR SKILLS AND OUTCOMES Catherine Nguyen, Hung Do, and Joel Gelman Catherine NguyenCatherine Nguyen More articles by this author , Hung DoHung Do More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Currently, the overwhelming majority of Reconstructive Urology Fellowships are located in the United States, whereas most countries in the world lack a single training center. In these countries, Urologists interested in becoming experts in urethroplasty often develop skills through informal training or on their own. Our United States - HCMC Vietnam outreach relationship was established in 2014 to improve urethral stricture treatment success in Vietnam by training a single Urologist through annual 2-week outreach trips. Recently, we expanded these workshops to include the participation of practicing Urologists from other countries seeking supplemental training. We report our early experience and the perceived value of a hands-on approach in comparison to "live" and "semi-live surgical broadcasts. METHODS: Urologists from Indonesia, Australia, Hong-Kong and Malaysia who perform urethroplasty without formal Fellowship training were invited to join the annual workshop. Every day included urethroplasty where participants observed and/or assisted in the cases. All participants completed a survey of their experiences anonymously to minimize bias. RESULTS: All 5 participants completed the survey. All previously attended semi-live and live broadcast meetings. All felt that being in the OR was the most useful educational tool, and live broadcast of surgery was the second most useful. All participants felt that the workshop helped them learn the pitfalls of reconstructive surgery. Most agreed that the workshop provided them with skills that will or has improved their surgical success rate. All participants agree this model should be continued and expanded. CONCLUSIONS: Data from our small initial study indicates that this post-graduate educational model is valuable for honing urethroplasty skills. Given the scarcity of training opportunities in male reconstructive urology outside of the United States, sub-specialty specific outreach workshops can and should be expanded to include the participation of Urologists from other countries seeking to serve as leaders in urethral reconstruction in their countries. With this model, which can be applied to other sub-specialties, global outreach trips will not only deliver care and provide training to the Urologists of the visited country, but also allow for the transfer of surgical skills to Urologists from other parts of the world where a formal Fellowship is not available. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e515-e515 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Catherine Nguyen More articles by this author Hung Do More articles by this author Joel Gelman More articles by this author Expand All Advertisement Loading ...

Surgical treatment of urethral stricture disease - the earlier, the better.

Surgical treatment of urethral strictures is a constantly evolving process. There are various treatment options like internal urethrotomy (IUT) and open surgery. A variety of techniques for urethral reconstruction are available (grafts, flaps, and excision-reanastomosis). Functional results of urethral reconstructive surgery are very satisfying and with low rate of complications. We assessed the early open surgical reconstruction in comparison with the continuation with the endourological treatment - IUTs. The study included 129 patients with urethral strictures referred to our center. At that time point, they had received two unsuccessful IUTs and were divided into two groups - consecutive IUT and surgical repair, which included excision and reanastomosis or augmented urethroplasty. These patients were evaluated at 12 months using urethrography and uroflowmetry. Sexual function was evaluated using the international index of erectile function questionnaire 5-IIEF. Chi-squared test for statistical analysis was used. Successful outcomes (urethrography presented equal caliber and Qmax was >15 ml/sec 12 months after the procedure) were achieved in 59 (88%) of the patients using reconstructive surgery versus 26 (41.9%) of the patients with consecutive IUT (p<0.001). Mild sexual dysfunction was reported by 12 (17.9%) patients from the group with open surgery and 7 (11.3%) from the group with continuous IUT (p=0.289). Early open surgery seems a reasonable solution to the problem of urethral strictures as there are only a few complications from this surgery and the functional results are satisfactory. The success rate using open surgery was found to be significantly greater than that in the consecutive IUT group, whereas no differences in the complication rates regarding sexual function were observed.

Temporary urethral stent with perineal fixation for posterior urethral stenosis (preliminary results)

Introduction. Urethroplasty is the “gold standard” treatment of urethral stenosis. However, often in connection with old and senile age, as well as due to the presence of concomitant diseases, it is not possible to carry out urethroplasty due to its certain invasiveness. In such cases, one of the methods of treatment is the installation of a urethral stent. But this method has not found practical application due to the frequent migration of stent and the high frequency of its incrustation. The approach developed by us avoids stent migration.Purpose of the study. To evaluate the immediate results of the placement of a urethral stent with fixation through the perineum.Materials and methods. A total of 18 patients with urethral stenosis aged 68 to 84 years have been operated on since February 2019. Ten patients had stenosis of the urethrocystoneoanastomosis after radical prostatectomy, 6 patients had iatrogenic stenosis of the prostatic urethra, 1 patient had post-radiation stenosis of the bulbo-membranous urethra. All patients in the preoperative and postoperative periods underwent: IPSS-QoL questioning, uroflowmetry, bladder ultrasound with residual urine volume evaluation, urethroscopy, ascending and micturition urethrocystography. The first stage was an internal optical urethrotomy according to the standard technique. Then, a urethral stent was installed in the area of dissected stenosis. The second stage was an incision in the perineum, the urethra was isolated, and under optical control, through the perineum, the stent was fixed to the urethra with non-absorbable suture material. The stent was removed endoscopically after 6 months.Results. The median surgery duration averaged 45 minutes. Patients were discharged 2 to 3 days after surgery. The maximum observation period was 20 months. During the observation period, not a single case of stent migration was recorded. All patients showed a persistent increase in Qmax and no residual urine. Six patients had a stress component of urinary incontinence, 4 patients had total urinary incontinence. According to control urethrocystoscopy 6 months after stent removal, clinically insignificant urethral stenosis was noted in all patients. In all cases, moderate signs of stent encrustation were identified. Dysuric phenomena disturbed 5 patients, who were stopped by rectal suppositories with NSAIDs, as well as taking herbal uroseptics. The data from the IPPS-QoL questionnaires confirm the positive effect of the treatment.Conclusions. Temporary placement of a urethral stent for urethral stenosis is an effective minimally invasive treatment. The technique of fixation through the perineum allows preventing migration in all cases. This approach to treatment significantly improves the quality of life of patients who were contraindicated for urethroplasty for one reason or another. However, the technique requires longer observation and analysis.

Relapses of urethral strictures associated with a pelvic ring fracture and osteosynthesis: the features of treatment and prevention

Introduction. Pelvic ring fracture with complex bone fragments displacement is associated with the urethral distraction injury in about 10% of cases. Emergency care for these patients includes the provision of trauma management and urinary diversion followed by delayed urethroplasty.Purpose of the study. To determine the effect of extramedullary osteosynthesis in a pelvic ring fracture on the outcome of treatment in patients with post-traumatic urethral strictures.Materials and methods. The study included 17 patients with post-traumatic urethral strictures associated with pelvic ring fractures (Types B, C). The average age of the patients was 35.8 ± 10.2 (19 - 61) yrs. All patients underwent submerged osteosynthesis and cystostomy drainage as an emergency. Localization of strictures: 10 (58.8%) - membranous, 7 (41.2%) - bulbo-membranous. Length of strictures: 1.47 ± 0.5 (0.5 - 2.5) cm. Post-traumatic period: 6.6 ± 1.3 (4 - 10) mo.Results. All patients underwent anastomotic urethroplasty. No early postoperative complications were identified. Spontaneous urination was restored by 14 - 15 days in all patients. Early urethral stricture relapses were revealed in 9 (52.9%) patients during 3-mo follow-up. These patients underwent removal of the metal structures fixing the pelvic bones. Repeated urethroplasty was performed a month later. Subsequent relapses of urethral stricture were not detected in any of 17 cases with a median follow-up of 28 (12 - 128) mo.Conclusion. Surgical treatment of urethral strictures associated with a pelvic ring fracture and osteosynthesis is advisable after removal of the metal structures fixing the pelvic bones. This is since the excessed retropubic screws protrusion (&gt; 0.2 - 0.3 mm) is associated with a large area of periurethral fibrous inflammation and causes high relapse risks of stricture disease (52.9%) in the case of urethral surgery preceding the removal of metal structures.

Update on the management of penile and meatal strictures.

Treatment of penile and distal urethral strictures including the fossa navicularis and the meatus remains challenging due to their adverse etiology and lack of ventral tissue support. In this contemporary review, we summarize the available evidence and recent advancements in reconstructive techniques. Over the last years, several refinements of already established techniques have been added to the reconstructive armamentarium in the management of penile urethral strictures. These include the single-stage combination of flap and graft, the additional use of tissue glue, or an optimized single-stage tubularization using a free graft. There is a shift toward an increased use of single-stage procedures even in complex strictures of the penile and distal urethra. This is reflected by advancements and refinements in operative techniques. Nonetheless, staged urethroplasty remains a cornerstone of curative management in such patients with durable success rates. Future research should focus on identifying distinct patient and stricture characteristics to determine the individual therapeutic approach with optimal functional outcomes.

Surgical outcomes and proposal for a treatment algorithm for urethral strictures in transgender men.

ObjectivesTo assess our results of surgical treatment for urethral strictures in transgender men, and to provide a surgical treatment algorithm.Patients and methodsA single centre, retrospective cohort study was conducted of transgender men who underwent surgical correction of their urethral stricture(s) between January 2013 and March 2020. The medical charts of 72 transgender men with 147 urethral strictures were reviewed. The primary outcomes were the success and recurrence rates after surgical treatment for urethral strictures.ResultsThe median (interquartile range [IQR]) follow‐up was 61 (25–202) months. At last follow‐up, 50/72 (69%) were able to void while standing (after one [60%], two [20%], three [6%], four [8%], five [4%], or seven [2%] procedures), 10/72 (14%) await further treatment, two of the 72 (3%) sat to void despite good urodynamic function, and 10/72 (14%) had a definitive urethrostomy. Of 104 surgical treatments included in separate success rate analysis, 65 (63%) were successful (43/75 [57%] after phalloplasty, 22/29 [76%] after metoidioplasty). The highest success rates in short urethral strictures were seen after a Heineke‐Mikulicz procedure (six of seven cases), and in longer or more complicated urethral strictures after two‐stage with graft (four of six), two‐stage without graft (10/12), pedicled flap (11/15, 73%), and single‐stage graft (seven of seven) urethroplasties. Grafts used were buccal mucosa or full‐thickness skin grafts. Success rates improved over time, with success rates of 38% and 36% in 2013 and 2014, to 71% and 73% in 2018 and 2019, respectively. We concluded with a surgical treatment algorithm based on previous literature, stricture characteristics, and our surgical outcomes.ConclusionThe highest success rates were seen after a Heineke‐Mikulicz procedure in short urethral strictures; and after graft, pedicled flap, or two‐stage urethroplasties in longer or more complicated urethral strictures. Finally, most of the transgender men were able to void while standing, although in some multiple surgical procedures were necessary to accomplish this.