Urethroplasty For Anterior Urethral Strictures Research Articles

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.

Comparison of oral morbidity and mid-term efficacy of anterior urethroplasty using an autologous tissue-engineered graft (MukoCell®) versus native oral mucosa graft.

Our study aimed to compare surgical success rate (SR) and oral morbidity of augmentation urethroplasty for anterior urethral strictures using autologous tissue-engineered oral mucosa graft (TEOMG) named MukoCell® versus native oral mucosa graft (NOMG). We conducted a single-institution observational study on patients undergoing TEOMG and NOMG urethroplasty for anterior urethral strictures >2 cm in length from January 2016 to July 2020. SR, oral morbidity, and potential risk factors of recurrence were compared between groups were analyzed. A decrease of maximum uroflow rate < 15 mL/s or further instrumentation was considered a failure. Overall, TEOMG (n = 77) and NOMG (n = 76) groups had comparable SR (68.8% vs. 78.9%, p = 0.155) after a median follow-up of 52 (interquartile range [IQR] 45-60) months for TEOMG and 53.5 (IQR 43-58) months for NOMG. Subgroup analysis revealed comparable SR according to surgical technique, stricture localization, and length. Only following repetitive urethral dilatations, TEOMG achieved lower SR (31.3% vs. 81.3%, p = 0.003). Surgical time was significantly shorter by TEOMG use (median 104 vs. 182 min, p < 0.001). Oral morbidity and the associated "burden" in patients' quality of life were significantly less at 3 weeks following the biopsy required for TEOMG manufacture, compared to NOMG harvesting and totally absent at 6 and 12 months postoperatively. The SR of TEOMG urethroplasty appeared to be comparable to NOMG at a mid-term follow-up but taking into account the uneven distribution of stricture site and the surgical techniques used in both groups. Surgical time was significantly shortened, since no intraoperative mucosa harvesting was required, and oral complications were diminished through the preoperative biopsy for MukoCell® manufacture.

PD35-10 IMPACT ON POSTOPERATIVE ORAL MORBIDITY AND MID-TERM EFFICACY OF ANTERIOR URETHROPLASTY USING AN AUTOLOGOUS TISSUE-ENGINEERED ORAL MUCOSA GRAFT (MUKOCELL®) VERSUS NATIVE ORAL MUCOSA GRAFT

You have accessJournal of UrologyCME1 Apr 2023PD35-10 IMPACT ON POSTOPERATIVE ORAL MORBIDITY AND MID-TERM EFFICACY OF ANTERIOR URETHROPLASTY USING AN AUTOLOGOUS TISSUE-ENGINEERED ORAL MUCOSA GRAFT (MUKOCELL®) VERSUS NATIVE ORAL MUCOSA GRAFT Leonidas Karapanos, Vincent Knorr, Luisa Halbe, Maximilian Schmautz, Bobirjon Ergashev, Andijan Uzbekistan, and Axel Heidenreich Leonidas KarapanosLeonidas Karapanos More articles by this author , Vincent KnorrVincent Knorr More articles by this author , Luisa HalbeLuisa Halbe More articles by this author , Maximilian SchmautzMaximilian Schmautz More articles by this author , Bobirjon ErgashevBobirjon Ergashev More articles by this author , Andijan UzbekistanAndijan Uzbekistan More articles by this author , and Axel HeidenreichAxel Heidenreich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The aim of our study was to compare the outcomes and complication rates of augmentation urethroplasty using autologous tissue-engineered oral mucosa graft (TEOMG) versus native oral mucosa graft (NOMG), aiming to determine the appropriate indications for TEOMG use (MukoCell®) in urethral surgery. METHODS: We conducted a single-institution retrospective study on 153 patients undergoing augmentation urethroplasty for anterior urethral strictures >2 cm in length from January 2016 to July 2020. TEOMG was used in 77 and NOMG in 76 patients, respectively. The success rate, complications including postinterventional oral morbidity, and risk factors of recurrence between both groups were analyzed. Postoperative follow-up (FU) examinations were performed at 6 and 12 months and subsequently yearly. A decrease of Qmax value <15 ml/s or further instrumentation were considered a failure. RESULTS: Overall, TEOMG and NOMG had comparable success rates (68.8% vs. 78.9%, p=0.155) after a median follow-up of 52 (IQR 45-60) months for TEOMG and 53.5 (IQR 43-58) months for NOMG. Subgroup analysis revealed similar success rates according to surgical technique, stricture localization, and length. Only following repetitive urethral dilatations, TEOMG achieved significantly lower success rates (31.3% vs. 81.3%, p=0.003). Surgical time could be reduced through TEOMG use with a median of 104 (IQR 86-130) vs. 182 (IQR 154-214) minutes in the NOMG group (p<0.001). Both early and late oral morbidity were diminished through the biopsy taken for TEOMG manufacture, compared to NOMG harvesting. Twelve months postoperatively, the prevalence of sensory disorders still showed a significant disparity between groups, with occurrence only in the NOMG group (0 vs. 9.2%, p=0.006). CONCLUSIONS: The success rate of augmentation urethroplasty using TEOMG was statistically comparable to NOMG at a mid-term FU. Surgical time was significantly shortened since no intraoperative mucosa harvesting was required, and oral complications were diminished through the preoperative biopsy for MukoCell® manufacture. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e978 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonidas Karapanos More articles by this author Vincent Knorr More articles by this author Luisa Halbe More articles by this author Maximilian Schmautz More articles by this author Bobirjon Ergashev More articles by this author Andijan Uzbekistan More articles by this author Axel Heidenreich More articles by this author Expand All Advertisement PDF downloadLoading ...

STUDY OF BUCCAL MUCOSA GRAFT URETHROPLASTY IN URETHRAL STRICTURES: A SINGLE CENTRE EXPERIENCE

Background/purpose: This study was conducted to present our experience in urethral mucosal graft urethroplasty to repair urethral stricture, bulbar, penile and pan anterior urethral stricture. This is a prospective hospital-Methods: based study that had been designed to review management outcomes of buccal mucosal graft urethroplasty for anterior urethral stricture from August 2017 to July 2021. The total number of involved patients was 50. The success rateResults: was found to be 92% (n=46), while 4 (8%) had a recurrence of stricture. Pain and pain combined bleeding from internal suture lines were the only early complication encountered in 40 (80%) and 2 (4%) patients, respectively. late complications occurred as follows 14 (28%) patients had UTI, 7 (14%) had wound infections, 7(14%) had changes in ejaculation, and decrease in intensity of orgasm, and 3 (6%) had erectile dysfunction. One of the long-term complications was graft diverticulum in one case and was treated conservatively (in ventral on lay BMG). Conclusion: BMG urethroplasty is a versatile technique for all types of anterior urethral stricture with all types of aetiologies with good long term results even in a small scale private hospital.

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%).

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study

ObjectiveThe objective of the study was to compare the outcome of tunica albuginea urethroplasty (TAU) and buccal mucosa graft (BMG) urethroplasty for anterior urethral stricture. MethodsThirty patients who met the inclusion criteria were randomised into two groups: TAU (Group A) and BMG urethroplasty (Group B). Surgical outcome was evaluated with pre- and post-operative work-up involving retrograde urethrogram, voiding cystourethrogram, uroflowmetry, and urethroscopy. Patients were followed up till 1 year. ResultsMean duration of surgery was statistically significant between two groups (p=0.0005). Maximum urine flow rate was comparable when compared between two groups (p=0.22) but statistically significant when compared pre- and post-operatively (p<0.001). At follow-up of 1 year, the successful outcomes were 80% in Group A and 87% in Group B. A total of five patients who had unsuccessful results required redo urethroplasty. Complications were minimal in both the groups. ConclusionTAU provides outcomes equivalent to those of BMG urethroplasty. TAU has less operative time, easy to perform, and beneficial in patients with poor oral hygiene.

P0403 - Feasibility and outcomes of dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: Follow-up of 60 months from a tertiary care center

P0403 - Feasibility and outcomes of dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: Follow-up of 60 months from a tertiary care center

Multi-Factorial Analysis of Recurrence and Complications of Lingual Mucosa Graft Urethroplasty for Anterior Urethral Stricture: Experience from a Chinese Referral Center

ObjectiveTo evaluate the risk factors that pertain to stricture recurrence and oral complications. MethodsPatients with long segmented anterior urethral stricture who visited our hospital from 2009 to 2016 were treated with lingual mucosa graft (LMG) urethroplasty. The incidence of complications in all of 128 patients were evaluated. The data were analyzed using the chi-squared test and Fisher's exact test. A multi-factorial regression analysis was performed to identify the risk factors responsible for the recurrence and complications. ResultsFor patients having LMG urethroplasty, there were no significant difference in recurrence of urethral stricture according to the studied variables. Binary logistic regression analysis reveals that previous surgery involving the urethra was a significant predictor of urethral stricture recurrence (odds ratio [OR]=5.07; 95% confidence interval [95% CI], 1.06–24.40; P = .043). The length of the substitute was significantly related to oral morbidity (P = .020), even after controlling for the studied variables. Patients with a harvested oral mucosa longer than 7 cm had a higher risk of oral morbidity than those with a harvested oral mucosa shorter than 7 cm (OR=4.35; 95% CI, 1.35–14.06; P = .014). ConclusionOur study shows that LMG urethroplasty is effective for patients with long segmented anterior urethral stricture. Previous urethral surgery was identified as a risk factor to cause recurrence and injury to the tip of the tongue for the oral complications.

Exploring the intersection of functional recurrence, patient-reported sexual function, and treatment satisfaction after anterior buccal mucosal graft urethroplasty

PurposeTo evaluate the interplay of stricture recurrence, sexual function, and treatment satisfaction after substitution urethroplasty.MethodsObservational study of men undergoing 1-stage buccal mucosal graft urethroplasty for anterior urethral stricture between 2009 and 2016. Patients were dichotomized by self-reported treatment satisfaction. Sexual function was assessed by validated and non-validated patient-reported outcome measures. Functional recurrence was defined as symptomatic need of re-intervention. Bivariate analyses, Kaplan–Meier estimates, qualitative and quantitative analyses by uni- and multivariable regression were employed to evaluate the interplay of sexual function, functional recurrence, and treatment satisfaction.ResultsOf 534 men with bulbar (82%), penobulbar (11%), and penile strictures (7.3%), 451 (84%) were satisfied with the surgery. There were no differences in stricture location, previous treatment, graft length, or surgical technique between satisfied and unsatisfied patients (all p ≥ 0.2). Recurrence-free survival was 85% at a median follow-up of 33 mo and decreased significantly with each Likert item towards increasing dissatisfaction (p < 0.001). Dissatisfied patients more often reported postoperative loss of rigidity, tumescence, reduced ejaculatory volume, ejaculatory pain, and reduced penile length (all p ≤ 0.042). In 83 dissatisfied men, functional recurrence (28%) and oral morbidity (20%) were the main drivers of dissatisfaction in qualitative analysis. Multivariable analyses revealed functional recurrence and impaired postoperative ejaculatory function as independent predictors of treatment dissatisfaction (all p ≤ 0.029) after adjusting for confounders.ConclusionWe found an association of both functional success and sexual function with patient-reported treatment satisfaction after substitution urethroplasty. Such findings validate the clinical significance of defining the symptomatic need for re-intervention as an endpoint and underline the importance of further research evaluating sexual function before and after open urethral reconstruction.

Dorsolateral inner preputial graft urethroplasty for anterior urethral strictures: long-term outcomes from a single tertiary care centre.

PurposeBuccal mucosa graft (BMG) is long used as favoured substitute by most reconstructive surgeons for substitution urethroplasty (SU). Though inner preputial skin graft (IPG) was described even earlier than BMG, its usage lately has fallen out of favour. The aim of the study was to evaluate the outcome of a SU with IPG from a tertiary care centre.MethodsA retrospective analysis of prospectively maintained clinical data was conducted at our tertiary care centre enrolling 80 patients with anterior urethral stricture from January 2015 to January 2018. Patients were evaluated for the aetiology, length and site of the urethral stricture. All patients underwent dorsolateral SU with IPG. Post-operative assessment including uroflowmetry and sexual outcomes using IIEF and MSHQ-EJD questionnaires was done at 3 weeks, 3 months, 12 months and half-yearly thereafter. Success was defined by the stable maximum urinary flow value > 14 ml/s or urethral calibration with 16 French Foley catheter.ResultsMean age of patients was 40 years (18–69). The most common aetiology was post-instrumentation (65%) and 60% had stricture at penobulbar site. Mean stricture length was 65 mm. At a mean follow-up of 48 months (range 30–66 months), successful outcomes were seen in 69/80 (87%). Patients with failure were managed with optical internal urethrotomy (OIU). Uroflowmetry and obstructive symptoms significantly improved and sexual function remained unaffected using IPG for SU.ConclusionsPreputial graft is a tissue familiar to the urologist, located very close to the surgical field, easily harvested and operated under regional anaesthesia. Overall success outcomes are acceptable to BMG urethroplasty.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-021-03613-9.

Outcome of OMG Urethroplasty by Asopa, Barbagli and Kulkarni Technique for Management of Anterior Urethral Stricture : Are Results Affected by the Surgical Technique?

Objective: To determine outcome of OMG urethroplasty by different surgical technique comparing ASOPA, BARBAGLI and KULKARNI TECHNIQUE in the management of anterior urethral stricture. Materials and Methods: A total of 62 patients with an average age of 42 yr(21-55) underwent OMG urethroplasty between 2008 to 2015 for anterior urethral stricture of different etiology. 2 patient lost durig follow up patient with lichen sclerosus and failed hypospadias were not included. OMG was always harvested from cheek using 2 team approach graft were placed using surgical technique of ASOPA, BARBAGLI and KULKARNI technique in 21,27 and 12 patients respectively clinical outcome was considered success or failure at the time any post operative procedure needed mean follow up was 45 month (6-95) Results: Out of 60 cases 51(85%) considered success and 9(15%) were considered failure. success rate were 85.7%,85%,and 83.5% in ASOPA, BARBAGLI and KULKARNI Technique and failure rate were 14.3%,15% and 16.7% respectively. Failure involve in the anastomotic site (2 in distal and 3 in proximal) were managed by OIU and involving whole length in 3 patient managed with staged urethropllasty. Conclusion: In our series, success rate of ASOPA, BARBAGLI and KULKARNI technique has no statistically significant variation. more over stricture recurrence was uniformly distributed in all group. so the outcome is not significantly affected by different technique used in OMG urethroplasty for anterior urethral stricture. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.23-27

Outcome of Dorsolateral OnlAy OMG Urethroplasty for Anterior Urethral Stricture

Objective: To determine the feasibility, safety, efficacy and short term outcome of using new surgical technique for repair of anterior urethral stricture Introduction: The conventional approach for management of long segment anterior urethral stricture is a two stage Johansons repair along with the use of free grafts if required. Now a days the preferred management of urethral stricture involving long segments of anterior urethra is dorsal only oral mucosa Augmentation urethroplasty which requires circumferential mobilization of urthera that might cause ischaemia of urethra in addition of chordee. For that we adopted new technique (kulkarnis) of dorsolateral onlay buccal mucosal graft one sided anterior urethroplasty in which only unilateral urethral mobilization done through perineal approach. Materials and Methods: A total of 50 patients underwent urethroplasty for anterior urethral strictures using dorsolateral onlay BMG from April 2010 to December 2012 at NIKDU, JBFH, BSMMU and BDM Hospital. We selected 16 to 70 years old male (mean age 39 years) underwent a one-sided dorsolateral oral mucosal graft urethroplasty. The mean (range) stricture length was 6.5 (4.5-9) cm in patients with single bulbar urethral involvement and 10.5 (8.5–15.0) cm in patients with panurethral strictures. Free graft was taken from oral mucosa either lower lip or cheeks. Follow up was done by uroflowmetry at 3rd week, after removal of penile catheter and repeat at 3rd and at 6th month. In addition to uroflometry – RGU &amp; MCU was done at 3rd month and Urethrocystoscopy was done at 6th month follow up. The results were classified into the following outcomes. Success was defined as a maximum flow rate of &gt;10 ml/sec, normal RGU, and/or urethroscopy (with a 19 Fr. sheath). Failure was defined as the presence of obstructive urinary tract symptoms, Qmax &lt;10 ml/sec, stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention. Result: The overall follow up was 12-30 months. Of the 50 patients 45 (90%) had a successful outcome and 5(12%) had failure. 3 failure treated by OIU and 2 by meatal dilatation. No significant donor site defect was observed. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.37-42

Is the Tongue an “Alternative Donor Site for Anterior Urethroplasty”?

Objective: To evaluate the effectiveness of a lingual mucosal graft (LMG) urethroplasty for long segment (&gt;2cm) anterior urethral strictures. Materials and Methods: A total of 30 patients underwent urethroplasty for anterior urethral strictures using dorsal onlay of a LMG from January 2009 to December 2010. We selected 21 to 56 years old (mean age 36.6). Stricture length was 22 to 59 mm (mean 36); 14 strictures were in the bulbar urethra, 09 were in the proximal penile and 07 were in both bulbar and penile urethra. Postoperatively all patients were followed with urethrography, uroflowmetry, cystourethrography and urethroscopy after 3weeks, 3 months and 06 months. Successful reconstruction criteria were peak flow rate greater than 15 ml per second and no need for postoperative urethral dilation. Results: The mean period of follow-up was 9 months (range 4-12). The overall success rate at 3rd week and 3rd month was 96.7% and at 6th month was 90%. Three patients developed repeat stricture at the anastomotic site. All the patients were able to resume oral fluid within 24 h, eat soft solid diet in 48–72 h and return to normal diet after 4– 5 days of surgery. No patient suffered from difficulty in opening the mouth, salivation disturbances, or difficulty in protrusion of tongue. Conclusions: LMG is easy to harvest. LMG seems to be associated with less postoperative pain and a minor risk of donor site complications or without any functional or esthetic deficiency. The tongue may be the best alternative donor site. Bangladesh Journal of Urology, Vol. 15, No. 1, Jan 2012 p.11-14

Outcomes of urethroplasty for anterior urethral strictures: A single-center experience

Purpose: The management of anterior urethral strictures is quite challenging due to high failure rates with many unavoidable postoperative complications. This study aims to elucidate the appropriate surgical techniques, advantages, and disadvantages of the different urethroplasties. Materials and Methods: We retrospectively recorded and analyzed twenty patients' demographics, surgical techniques, postoperative uroflowmetry, and complications. Patients were divided into two groups depending on the length of their strictures. Patients in Group 1 presented a urethral stricture or obliteration length of

Dorsolateral Onlay Buccal Mucosal Urethroplasty for Anterior Urethral Strictures by Unilateral Urethral Mobilization

Purpose: Complete urethral mobilization may endanger the lateral vascularity of the urethra in buccal mucosal graft (BMG) urethroplasty in stricture urethral disease. The present study aimed to evaluate the outcomes of BMG urethroplasty by dorsolateral onlay technique in patients with anterior urethral stricture. Materials and Methods: This was a prospective interventional study conducted at the Department of Urology at PSG Institute of Medical Sciences and Research between January 2015 and December 2018. Patients diagnosed with anterior urethral stricture who underwent dorsolateral onlay urethroplasty were included in this study. Results were considered satisfactory with the Qmax between 8 mL/s and 15 mL/s. Failed outcome was defined as persistent lower urinary tract symptoms, stricture on retrograde urethrogram, Qmax &lt;8 mL/s, and requiring repeated urethra intervention. Results: A total of 54 patients underwent BMG urethroplasty by dorsolateral onlay graft with a mean age of 47.6 years. The patients with a range of stricture length 3–14 cm were included in this study. Short-term success rate (Qmax &gt;15 mL/s) was achieved in 42 patients, while satisfactory results (Qmax 8–15 mL/s) were observed in nine patients and failure (Qmax &lt;8 mL/s) occurred in three patients. Oral and perineal complications were treated conservatively with oral antibiotics and analgesia. None of the patients in this study had a postoperative perineal hematoma, graft infection, and scrotal swelling. Conclusion: Overall observations suggest that dorsolateral onlay BMG urethroplasty with unilateral urethral mobilization for an anterior urethral stricture is a feasible and effective option with favorable outcomes.

Critical analysis of urethroplasty for male anterior urethral stricture: a single-center experience.

Urethroplasty is the most effective treatment method for anterior urethral strictures, which constitute an important health concern for males. This study aims to investigate factors that may predict treatment failure following urethroplasty for anterior urethral strictures and evaluate outcomes of different urethroplasty techniques. This retrospective study utilized univariate and multivariate analyses to identify factors affecting treatment success following different urethroplasty techniques performed by a single surgeon on male patients with anterior urethral strictures. Surgical outcomes of different urethroplasty techniques were evaluated individually. Urethroplasty procedures performed on 244 patients with a mean age of 54years and a mean stricture length of 4.7cm produced a success rate of 79.1%. Multivariate analyses identified stricture length and number of previous internal urethrotomy procedures as factors predicting urethroplasty success (HR 1.265, 95% CI 1.129-1.416, p < 0.001 and HR 1.188, 95% CI 1.038-1.361, p = 0.013, respectively). The eight surgical techniques used by the surgeon produced success rates that varied between 50% and 86.2%. Urethroplasty can offer satisfactory outcomes for anterior urethral strictures. Accordingly, a longer stricture length and greater number of previous internal urethrotomy procedures were associated with greater risk for urethroplasty failure. Moreover, urethroplasty techniques must be selected based on multifactorial evaluation and performed at experienced centers.

Evaluation of the effect of urethroplasty for anterior urethral strictures by a validated disease-specific patient-reported outcome measure.

To better understand our urethroplasty outcome, we translated the English version of a urethral stricture surgery patient-reported outcome measure (USS-PROM) into Japanese and used it to evaluate the effect of urethroplasty for anterior urethral strictures. The PROM quantifies lower urinary tract symptoms (LUTS) and health-related quality of life (EQ-5D), and it evaluates overall satisfaction by asking patients to choose "very satisfied", "satisfied", "unsatisfied", or "very unsatisfied". 93 Japanese-speaking male patients with anterior urethral stricture who underwent urethroplasty completed it before (baseline) and 6months after urethroplasty. The psychometric criteria evaluated in the present study were the PROM's internal consistency, test-retest reliability, criterion validity, and responsiveness. Qmax was negatively correlated with the LUTS-total scores (r = - 0.61). Cronbach's alpha was 0.80 and the test-retest intraclass correlation coefficient for the LUTS-total score was 0.82. 83 patients (89.2%) achieved stricture-free, which was defined as no re-stricture on cystoscopy and no need for additional treatment. The mean total LUTS-score improved from 12.4 at baseline to 3.7 postoperatively (p < 0.0001). The mean EQ-5D visual analogue scores and EQ-5D index improved from 61.2 and 0.76, respectively, at baseline to 77.9 and 0.89 postoperatively (p < 0.0001, p < 0.0001). 55 patients (59.1%) were "very satisfied" with the outcome of their urethroplasty and 33 (35.5%) were "satisfied". The Japanese version of the USS-PROM has adequate psychometric properties. Urethroplasty improved not only objective data but also voiding symptoms and health-related QOL, and it resulted in a high rate of patient satisfaction.

Evaluation of the effect of urethroplasty for anterior urethral strictures by a validated disease specific patient-reported outcome measure

To better understand our urethroplasty outcome, we translated the English version of a urethral stricture surgery patient-reported outcome measure (USS-PROM) into Japanese and used it to evaluate the effect of urethroplasty for anterior urethral strictures. The PROM quantifies lower urinary tract symptoms (LUTS) and health-related quality of life (EQ-5D), and it evaluates overall satisfaction by asking patients to choose “very satisfied”, “satisfied”, “unsatisfied”, or “very unsatisfied”. 93 Japanese-speaking male patients with anterior urethral stricture who underwent urethroplasty completed it before (baseline) and 6 months after urethroplasty. The psychometric criteria evaluated in the present study were the PROM’s internal consistency, test–retest reliability, criterion validity, and responsiveness. Qmax was negatively correlated with the LUTS-total scores (r = − 0.61). Cronbach’s alpha was 0.80 and the test–retest intraclass correlation coefficient for the LUTS-total score was 0.82. 83 patients (89.2%) achieved stricture-free, which was defined as no re-stricture on cystoscopy and no need for additional treatment. The mean total LUTS-score improved from 12.4 at baseline to 3.7 postoperatively (p < 0.0001). The mean EQ-5D visual analogue scores and EQ-5D index improved from 61.2 and 0.76, respectively, at baseline to 77.9 and 0.89 postoperatively (p < 0.0001, p < 0.0001). 55 patients (59.1%) were “very satisfied” with the outcome of their urethroplasty and 33 (35.5%) were “satisfied”. The Japanese version of the USS-PROM has adequate psychometric properties. Urethroplasty improved not only objective data but also voiding symptoms and health-related QOL, and it resulted in a high rate of patient satisfaction.

Buccal mucosal graft urethroplasty in men-risk factors for recurrence and complications: a third referral centre experience in anterior urethroplasty using buccal mucosal graft.

BackgroundUrethral stricture disease is a challenging condition to treat and several approaches including direct visual internal urethrotomy (DVIU) and anastomotic or augmentation urethroplasties based on the use of flaps and graft have been reported. The aim of this study is to determine risk factors for stricture recurrence and complications in patients having buccal mucosal graft (BMG) urethroplasty for anterior urethral stricture under a single surgeon in a third referral centre in UK.MethodsWe conducted a retrospective review of a prospectively gathered database of 128 patients having various forms of BMG urethroplasty between 2001 and 2015. Success and failure in terms of stricture recurrence, patient demographics, stricture aetiology and anatomy, and the adverse outcomes of: post-micturition dribbling (PMD), erectile dysfunction (ED) >12 months and complications were recorded in order to determine risk factors for recurrent stricture and complications.ResultsThe mean age of all patients was 42.8 years (range, 16–74 years). Average follow-up was 45 months (range, 3–159 months). The total re-stricture rate was 19% (24 men). PMD was reported in 16% (n=20) and ED in 12.5% (n=16). All ED was none organic and responded to oral PDE5 inhibitor treatment. Post-operative complications were reported in 16 patients (12.5%). The most frequent complications recorded were urinary fistula (n=4; 3.1%), graft contracture (n=4; 3.1%) and graft failure (n=4; 3.1%), all reported after penile urethroplasty. Univariate analysis indicated that age at surgery, stricture length, site and aetiology were all significant risk factors for stricture recurrence. On multivariate analysis penile site was the only significant independent variable for restricture.ConclusionsBMG urethroplasty represents a reliable therapeutic option for patient with urethral strictures with a success rate of 81% at 45 months of follow-up. Complications are more common in complex stricture of the penile urethra. On multivariate analysis penile site was the only significant independent variable for re-stricture.

Changes in Nocturnal Bladder Diary Parameters in Men after Urethroplasty for Anterior Urethral Strictures

Changes in Nocturnal Bladder Diary Parameters in Men after Urethroplasty for Anterior Urethral Strictures