The dynamic pathological microenvironment formed post-urethral injury drives an inflammatory-fibrotic cascade, leading to urethral stricture. Herein, we designed a novel hydrogel dressing (CPT-Cel) to modulate this dynamic urethral microenvironment for scarless reconstruction. The hydrogel responsively degrades and releases its contents upon encountering acidic environments and ROS bursts, interrupting the severe oxidative stress-inflammation cycle and creating a favorable regenerative microenvironment in the early wound phase. The incorporated celastrol continuously releases into the late repair phase, inhibiting the hyperactivation of urethral fibroblasts via the TGF-β/NF-κB pathway in urethral microenviroment, thereby preventing excessive collagen secretion. Furthermore, the dressing, featuring an ECM-mimicking microstructure, effectively adheres to and integrates with the injury site, providing hemostatic and antibacterial functions. In animal models of urethral injury, CPT-Cel accelerated urethral repair within the inflammatory milieu, significantly reduced collagen deposition and ultimately improved stricture outcomes. This study not only validates the core mechanism by which an intelligent drug-loaded hydrogel modulates the dynamic urethral microenvironment but also proposes a new paradigm for urethral tissue engineering.

For polytrauma patients who may have life-threatening injuries, renal and genitourinary trauma may be overlooked initially, but a delayed or missed diagnosis of these injuries may result in potentially preventable complications. This review provides a best-practice approach to the diagnosis and management of renal and genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid long-term sequelae such as hypertension, incontinence, urethral stricture, erectile dysfunction, chronic kidney disease, and nephrectomy.

To evaluate long-term outcomes of open urorectal fistula (URF) repair, including URF recurrence, need for re-intervention, and patient-reported outcomes. This retrospective study included men undergoing open URF repair between 2014 and 2024. Data collected encompassed comorbidities, prostate cancer treatment history, prior URF interventions, and intraoperative details. Endpoints were: (i) URF recurrence-free survival, (ii) re-intervention-free survival (no further disease-related procedures), and (iii) validated patient-reported outcome measures (PROMs). Kaplan-Meier estimators were used for survival analyses; PROMs were scored according to standard protocols. A total of 29 patients underwent open URF repair. The median (interquartile range [IQR]) age was 68 (61-71) years, body mass index was 26 (23-28) kg/m2, and the time from prostatectomy to URF repair was 10 (4-13) months. Five patients (17%) had prior pelvic radiotherapy; 13 (45%) underwent redo repairs. Presenting symptoms included rectal urine leakage (48%), pneumaturia (24%), recurrent infections (21%), dysuria (21%), and faecaluria (10%). Transperineal repair was performed in 26 patients (90%) and transabdominal repair in three (10%). The median (IQR) operating time was 90 (80-107) min. The median follow-up was 50 months for recurrence and 58 months for re-intervention. The 5-year URF recurrence-free and any disease-related re-intervention-free survival estimates were 96% and 75%, respectively. The median (IQR) six-item lower urinary tract symptoms score from the Urethral Stricture Surgery PROM was 4 (2-8), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form sum score was 11 (6-15), Wexner faecal incontinence score was 3 (1-9), International Consultation on Incontinence Questionnaire-Satisfaction outcome score was 21 (18-23), and Decision Regret Scale score was 0 (0-10), indicating restored voiding function, moderate urinary incontinence, mild faecal incontinence, high patient satisfaction, and negligible decisional regret. Open URF repair achieves durable URF closure with favourable long-term outcomes, even in complex cases. Patient satisfaction is high, while moderate urinary incontinence persists in some, likely reflecting underlying disease. Voiding and faecal continence remain largely preserved.

Radiotherapy of the pelvis and abdomen can have significant negative long-term effects on the bladder and urethra. Applying the PICO criteria, we reviewed the MEDLINE/PUBMED databases over a 10-year period for literature on the incidence and prevalence of late adverse effects of radiotherapy on the lower urinary tract; the work-up and management of these adverse effects. Overactive bladder, hemorrhagic cystitis, fistula, stress urinary incontinence, bladder neck contracture, urethral stricture, and secondary malignancy were investigated as late complications of radiotherapy on the bladder and urethra. These sequalae may present in the decades following radiotherapy usually with greater symptom severity than those non-irradiated and will often have less favourable outcomes with traditional management strategies that are applied in the absence of radiation. Experimental therapies are being trialed. Our findings reinforce that patients with radiotherapy-related complications most often have poorer outcomes with traditional management strategies such as male urethral slings for stress incontinence and fistula repair, however this review identified successful outcomes for treatments such as the artificial urethral sphincter for incontinence, and hyperbaric oxygen therapy for hemorrhagic cystitis. Further research is required - particularly with a focus on the irradiated female population.

Revision Hypospadias Repair in Adolescence: A Scoping Review.

Hyperbaric oxygen therapy attenuates urethral stricture formation after urethral injury: an experimental rabbit study.

Urethroplasty is the gold standard for recurrent urethral stricture disease per the 2016 American Urological Association (AUA) guideline. Its sustainability depends on economic viability; however, recent payment cuts and inflationary pressures threaten reimbursement. This study analyzed: (1) trends in Medicare providers performing urethroplasty, (2) urethroplasty procedure volumes, and (3) nominal and inflation-adjusted Medicare reimbursement from 2013-2023, contextualized against comparator urologic procedures. This was a retrospective, cross-sectional study using the Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule and Medicare Part B Physician and Other Practitioners datasets from 2013-2023. Urethroplasty procedures were identified using CPT codes 53,400, 53,405, 53,410, 53,415, and 53,430. Comparator procedures included Cystourethroscopy with Direct Vision Internal Urethrotomy (DVIU, CPT 52276) and Endoscopic/Robotic-Assisted Radical Prostatectomy (CPT 55866). Reimbursement values were adjusted to August 2025 U.S. dollars using the Consumer Price Index. Urethroplasty provider numbers and procedure volumes increased 33-45% and 36-65%, respectively. Nominal urethroplasty reimbursement remained stable (-2.5% to + 22.8%), while inflation-adjusted reimbursement declined 18-25% across all types. By contrast, DVIU demonstrated declining provider participation (-33.9%) and procedure volumes (-46.5%), with inflation-adjusted reimbursement declining 27.4%. Endoscopic prostatectomy showed growing provider participation (+ 33.4%) and volumes (+ 27.3%), but experienced the most severe nominal (-26.5%) and inflation-adjusted (-43.5%) reimbursement decline of all procedures examined. Urethroplasty faces a distinctive economic burden: rising clinical demand paired with stagnant nominal and substantially declining real reimbursement. While reimbursement erosion affects all urologic procedures studied, the combination of increasing utilization and inadequate payment adjustment is uniquely pronounced for reconstructive urology. Long-term sustainability will require reimbursement models that align payment with evidence-based, high-value surgical care.

Urethral stricture, a prevalent urological disorder characterized by fibrosis of periurethral tissues, severely compromises urinary function and patient quality of life. Despite various clinical interventions, recurrence remains frequent, largely due to the lack of physiologically relevant in vitro models for mechanistic investigation and drug screening. Here, we present a biomimetic urethra-on-a-chip platform that integrates microfluidics, three-dimensional (3D) printing, and near-field electrospinning to recapitulate the structural and biochemical complexity of the native urethra. The device features polydimethylsiloxane (PDMS) microchannels coupled with a multilayered polycaprolactone (PCL) membrane, functionalized using a bladder acellular matrix (BAM)-gelatin bioink to emulate the extracellular matrix (ECM) microenvironment. A bilayer microchamber configuration supports spatially organized coculture of fibroblasts and urothelial cells under dynamic perfusion, reproducing physiological shear stress and nutrient gradients. Under fibrotic stimulation by transforming growth factor beta 1 (TGF-β1), the system faithfully mimicked fibroblast activation and epithelial injury, while rapamycin treatment effectively attenuated fibrotic responses, validating its potential for pharmacological testing. This urethra-on-a-chip provides a robust, reproducible, and cost-efficient platform for modeling urethral fibrosis and evaluating antifibrotic therapeutics. By bridging biofabrication, microfluidics, and tissue pathophysiology, this work establishes a versatile organ-on-a-chip model with significant implications for translational research and personalized regenerative medicine.

Treatment Trends for Anterior Urethral Stricture: An International Survey on Eligibility for Staged Urethroplasty.

To report our experience with laparoscopic-assisted anorectoplasty (LAARP) for anorectal malformations (ARM) performed without ligation of the rectourinary fistula (RUF). In this single-center study, we retrospectively analyzed all consecutive primary LAARP procedures for ARM without RUF ligation performed between 2004 and 2022. Forty patients were included (19 rectobulbar, 16 rectoprostatic, 5 rectobladder). Colostomy was performed at a median age of 1 day and LAARP at 147 days (median weight 6 kg). Median operative time was 180 minutes, and 1 patient required conversion. No early complications were associated with omission of RUF ligation. Foley catheters were kept for a median of 10 days, postoperative stay was 5 days, and colostomy closure occurred at 7 months. The median follow-up was 6.7 years. Cystoscopy and cystography were performed in 17% and 20% of patients, respectively, with no remnants of the original fistula (ROOF). Eight patients (20%) had urological issues: neurogenic bladder (n = 3), bladder dyssynergia (n = 2), urinary retention (n = 2), and non-LAARP-related urethral stenosis (n = 1). Regarding late outcomes, 2 patients (5%) underwent redo anorectoplasty, 11 (27%) required prolonged dilations, 4 (10%) underwent redo anoplasty, and 2 (5%) underwent revision for mucosal prolapse. Among those >4 years, 84% had voluntary bowel movements, 76% soiling, and 52% constipation; 53% of those <4 years required laxatives. LAARP without ligation of the RUF for ARM appears to be a safe and effective technique, with favorable long-term urological and functional outcomes. No patients experienced urethral injury or ROOF.

A0529 Perioperative outcomes and prevalence of urethral strictures during surgery for benign prostatic hyperplasia: Results from the GRAND study

Male genital lichen sclerosis (mGLS) is a chronic progressive inflammatory disease with potential complications including urethral strictures and penile cancer. Despite its clinical significance, the molecular mechanisms underlying mGLS remain poorly understood, and male-specific data are limited. This systematic review consolidates current evidence on tissue-based gene and protein expression in mGLS, aiming to identify commonly investigated biomarkers and highlight gaps in the literature. Using the JBI Sumari interface, our research strategy identified a total of 24 studies with considerable variability in targets and methodologies. Only a small subset of 12 genes and proteins was assessed and only one gene, p16, was assessed across multiple studies, limiting the strength of conclusions. QIAGEN Ingenuity Pathway Analysis was used to explore canonical pathways and disease associations linked to reported biomarkers. While preliminary patterns suggest involvement of inflammatory and fibrotic pathways, further research is needed to validate these findings and assess their diagnostic, prognostic or therapeutic potential. This review provides a foundation for future studies focused on improving molecular understanding and clinical management of mGLS.

P0062 Autologous live-cultured buccal epithelial cells for bulbar urethral strictures: 24-months follow-up results

V034 Urethroplasty using double-face buccal mucosa grafts for obliterative penile urethral strictures involving the fossa navicularis

P0802 Predicting urethral stricture recurrence after urethroplasty: Key risk factors and postoperative indicators

P0069 The injectable gelatin-sodium alginate drug delivery systems for urethral stricture disease through the enhancement of tissue repair and prevention of fibroblast-driven extracellular matrix remodeling

A0800 Comparative outcomes of dorsal onlay urethroplasty using labia minora, buccal mucosal, and vaginal wall grafts in female urethral stricture

P0800 Routine low-dose tadalafil following buccal mucosal graft urethroplasty for bulbar urethral strictures: Influence on urinary, sexual, and patient-reported functional outcomes — a prospective cohort of 170 patients

A0798 VeSpAR trial: A randomized controlled trial comparing vessel-sparing anastomotic repair and transecting anastomotic repair in isolated, short, bulbar urethral strictures

A0807 5-year outcomes of optilume for recurrent anterior urethral strictures: Pooled results from the robust I, II and III trials