Type Of Urethroplasty Research Articles

Comparison of outcome of TIP urethroplasty with or without Buck’s Fascia repair

ObjectiveTIP is the most common preformed type of Urethroplasty. The intermediate barrier is used as a waterproofing layer to prevent fistula formation. Many tissues have been utilized as a barrier layer, with varying success rates. The search for a better intermediate layer will continue. In this study, we aim to evaluate the role of Buck’s Fascia as a covering for the neo-urethra to prevent fistula formation in patients who underwent Snodgrass Urethroplasty.MethodsThis prospective study was conducted between 2018 and 2022. Patients were randomly assigned to either Group ‘A’ or Group ‘B’. Group A included patients who underwent the Snodgrass procedure with a Buck’s Fascia cover, while Group B included patients whose neo-urethra was covered with the dartos flap. These patients were closely monitored for the development of short- and long-term complications in both groups, and the results were recorded.ResultsThe study involved 164 patients, who underwent midpenile and distal hypospadias repair using the Snodgrass technique. In Group ‘A’ (84 patients), the neo-urethra was covered with Buck’s Fascia, while in Group ‘B’ (80 patients), the neo-urethra was covered with the dartos flap. The mean age of the children was (23.06 ± 16.12) months in group ‘A’ & (26.06 ± 14.07) months in group ‘B’. mean operating time was (40 ± 11.43) minutes, in Group ‘A’, and (70 ± 17.43) minutes, in Group ‘B’. Meatal stenosis occurred in 3.57% of children in Group ‘A’ and 10% of patients in Group ‘B’. Urethral fistulas were encountered in 2.35% of cases in Group ‘A’and 10% in Group ‘B’. The difference between the groups was statistically significant.

Retrospective Comparison of Postoperative Complications of Different Types of Urethroplasty in Patients with Long Urethral Strictures and Obliterations

.The objective: is to evaluate postoperative complications after various types of urethroplasty. Material and methods. The clinical data of the medical histories of 176 patients with long urethral strictures and obliterations were retrospectively assessed. Regarding the types of surgical operations, patients were divided into 3 groups: 1 group – buccal plastic urethra (BPU) – 93 (52.8%), 2 group – urethro-urethro- or urethro-prostate anastomosis (UUA) – 67 (39.8%), 3 group – replacement plastic surgery with a skin-fascial flap (PSF) – 16 (9.1%). In the postoperative period, the presence of early and late postoperative complications was assessed. Complications were evaluated according to the Clavien-Dindo scale. According to this classification, 3 groups were formed: group A – patients without complications or with class I complications – 110 (62.5%), group B – patients with postoperative complications II–IIIa according to the Clavien-Dindo classification – 36 (20.5%), group C – men with class IIIb-IV complications – 30 (17.0%). There were no class V complications after surgery. Results. When evaluating the length of urethral strictures and obliterations of patients of group A, it ranged from 2 to 7 cm in 46 (41.8%) cases, and in 59 patients the strictures were longer than 7 cm, in 5 (4.5%) patients the length was less than 2 cm. In all three groups, the majority of strictures were more than 2 cm: in group B, 50% of strictures were from 2 to 7 cm, and in 44.4% more than 7 cm. In group C, 16 patients (53.3%) the strictures were more than 7 cm long. But when comparing the average length of the urethral stricture between the groups, a significant difference is observed between group A and group B, as well as between group A and group C. In group A, according to the type of surgical treatment performed, most patients were divided into 41 (37.3%) UUA and 59 (53.6%) BPU among all patients who underwent surgical interventions. There were 10 (9.1%) group A patients after PSHFL. Group B patients with class II-IIIa complications were more numerous after BPU – 24 (66.7%), 10 (27.8%) patients were after UUA, and 2 (5.5%) patients were after PSHFL. When evaluating the difficulty of urethral strictures, the highest score was found in group C of patients 8.6±1.4, in group B it was slightly lower at 8.3±1.7 points. In group A, the complication score was lower and was 7.1±2.2, indicating that most of the urethral strictures in our study were complicated. There is a probable difference between groups A and B, and groups B and C. Conclusions. Statistically significant risk factors for the occurrence of postoperative complications are length, the presence of 2–3 degrees of spongiofibrosis, the complexity of stricture/obliteration of the urethra.

Urethroplasty Methods for Stricture Repair After Gender Affirming Phalloplasty: High Failure Rates in a Hostile Surgical Field

To report our experience with 71 postphalloplasty urethral strictures in order to discuss the performance characteristics of different urethroplasty techniques in urethral stricture after phalloplasty. We conducted a retrospective chart review of 85 urethroplasties performed for stricture repair in 71 patients with phalloplasty for gender affirmation between August 2017 and May 2020. Stricture location, urethroplasty type, complication rate, and recurrence rate were recorded. The most common stricture type was distal anastomotic (40/71, 56%). The most common initial repair type was excision and primary anastomosis (EPA) (33/85, 39%), followed by first-stage Johanson urethroplasty (32/85, 38%). The stricture recurrence rate after initial repair of all types was 52% (44/85). The recurrence rate of stricture after EPA was 58% (19/33). The recurrence rate after staged urethroplasty was 25% (2/8) for patients who successfully completed a first and second stage. 30% (3/10) of patients who completed a first stage and opted out of a second stage required a revision to achieve successful lifetime voiding from the surgical urethrostomy. EPA after phalloplasty has a high failure rate. Nontransecting anastomotic urethroplasty has slightly lower failure rate, and staged Johanson-type surgeries have the highest success rates after phalloplasty.

Перинеальная уретростомия: результаты, клинико-статистические и терминологические аспекты

The analysis of the results of perineal urethrostomy for urethral stricture in men for the period from 2000 to 2020 is presented in the article. We identified 29 original articles devoted to this technique, including 4 Russian and 25 foreign publications. In two studies, there were more than 100 patients, four studies included from 51 to 77 men, and in remaining studies less than 50 patients were analyzed. Complete data on all pre- and postoperative aspects of perineal urethrostomy were provided only in a few studies. In the overwhelm of cases, perineal urethrostomy was performed after one or several unsuccessful reconstructive procedures and only in few patients it was done prior to various types of urethroplasty. It was not possible to establish any association between etiological factors and localization of urethral stricture among these patients. The incidence of pan-urethral stricture ranged from 28.6% to 100%. Only in one study the average stricture length was 2 cm, while in all other studies it was 5 cm or more. Postoperative follow-up was on average 14 to 62 months. Treatment success with perineal urethrostomy ranged from 0% to 100%, but in most studies it was 75% or more. The most common perineal urethrostomy technique used included Blandy technique, and Johanson and 7-flap techniques.

Accurately Defining the Incidence and Associations of 90-Day Complications after Urethroplasty: Adverse Impact of Patient Comorbidities, Preoperative Bacteriuria and Prior Urethroplasty.

The purpose of this study was to determine the incidence of 90-day complications after urethroplasty and identify factors associated with them. A single-institution, 2-surgeon retrospective review was performed on patients undergoing urethroplasty from August 2003-June 2020. Variables included the incidence, type and Clavien-Dindo grade of complications, patient age, individual comorbidities, comorbidity component of the Charlson Comorbidity Index (CCI), smoking status, obesity (body mass index ≥35 kg/m2), bacteriuria, type of urethroplasty, stricture etiology, length, location, prior endoscopic procedures, previous urethroplasty and preoperative suprapubic catheterization. The primary outcome was the incidence of significant 90-day complications defined as Clavien grade ≥2. Descriptive statistics were used to summarize the results and binary logistic regression was used to examine the factors associated with 90-day complications. Of the 1,611 patients included in the analysis, 90-day complications (Clavien ≥2) occurred in 7.9% (128/1,611) and were wound related (3.5%), urinary tract infection (3.4%), cardiovascular (0.4%), catheter-related (0.2%), hematuria (0.1%) or retention (0.1%). On univariable binary logistic regression stricture location (p=0.04), stricture length (p=0.009), CCI (p <0.0001), prior urethroplasty (p=0.01) and bacteriuria (p=0.002) were associated with complications, while age (p=0.3), etiology (p=0.2), smoking (p=0.2), obesity (p=0.3), failed endoscopic treatment (p=0.8), indwelling suprapubic catheter (p=0.7) and type of urethroplasty (p=0.09) were not. On multivariable analysis, increasing CCI (Odds Ratio 1.31, 95% CI 1.10-1.56; p=0.003), prior urethroplasty (OR 1.86, 95% CI 1.09-3.17; p=0.02) and preoperative bacteriuria (OR 1.67, 95% CI 1.14-2.45; p=0.009) remained associated with 90-day complications. Patients with increased comorbidities, prior urethroplasty and preoperative bacteriuria are at higher risk for complications after urethroplasty and should be counseled accordingly in a shared decision-making model of care.

Comparative analysis of one- and two-stage urethroplasty in the treatment of proximal hypospadias in children: flap or transplant?

BACKGROUND: Surgical treatment of proximal forms of hypospadias in children is still a complex and largely unsolved problem. The large number of postoperative complications following reconstructive surgery for proximal forms of hypospadias supports scientific interest in this issue.&#x0D; AIM: This study aimed to conduct a retrospective comparative analysis of the effectiveness of two types of urethroplasty. We compared fundamentally different approaches to the formation of the artificial urethra, surgical techniques that use a different type of movement, and blood supply of the plastic materials a flap and a graft.&#x0D; MATERIALS AND METHODS: The study included 113 primary patients with proximal hypospadias aged 8 months to 15 years who underwent surgery between 2013 and 2019 and were divided into two comparison groups. Group 1 included 53 (46.9%) boys; a single-stage urethroplasty was performed by the onlay-tube method, where a longitudinal skin flap of the dorsal surface of the penis was used as a plastic material. Group 2 included 60 (53.1%) patients; two-stage urethroplasty was performed by the Bracka method, where the plastic material for the formation of the artificial urethra was a preputial graft in 44 (73.3%) patients and a graft of the oral mucosa in 16 (26.7%) patients.&#x0D; RESULTS: When comparing the surgical results in the form of the number of complications requiring repeated surgical interventions under anesthesia to eliminate them, corresponding to ClavienDindo 3B complications, a significant difference was obtained in the study groups. The surgical results were significantly better when performing the two-stage Bracka method.&#x0D; CONCLUSIONS: In the surgical treatment of proximal forms of hypospadias in children, the two-stage Bracka method, where the plastic material for the formation of the artificial urethra is a preputial or mucosal graft, significantly reduced the number of postoperative complications.

Metoidioplasty: Surgical Options and Outcomes in 813 Cases.

IntroductionMetoidioplasty is a variant of phalloplasty for transmen that includes the creation of the neophallus from a hormonally enlarged clitoris, urethral lengthening and scrotoplasty. The procedure results in male appearance of genitalia, voiding in standing position and preserved sexual arousal, but without possibility for penetrative intercourse. We evaluated outcomes of metoidioplasty at our center, based on latest surgical refinements.MethodsDuring the period of 14 years (from February 2006 to April 2020), 813 transmen with mean age of 24.4 years and mean body mass index of 24.6, underwent one stage metoidioplasty. Hysterectomy was simultaneously performed in 156, and mastectomy in 58 cases. Hysterectomy, mastectomy and metoidioplasty were done as a one-stage procedure in 46 transmen. Patients are divided in 5 groups, depending on the type of urethroplasty. Postoperative questionnaires were used to evaluate cosmetic and functional outcomes, as well as patients’ satisfaction.ResultsFollow-up ranged from 16 to 180 months (mean 94 months). Mean surgery time was 170 minutes and mean hospital stay was 3 days. Length of the neophallus ranged from 4.8 cm to 10.2 cm (mean 5.6 cm). Urethroplasty was complication-free in 89.5% of cases, and ranged between 81% to 90.3% in different groups. Urethral fistula and stricture occured in 8.85% and 1.70% of cases, respectively. Other complications included testicular implant rejection in 2%, testicular displacement in 3.20% and vaginal remnant in 9.60% of cases. From 655 patients who answered the questionnaire, 79% were totally satisfied and 20% mainly satisfied with the result of surgery. All patients reported voiding in standing position and good sexual arousal of the neophallus, without possibility for penetrative intercourse due to small size of the neophallus.ConclusionMetoidioplasty has good cosmetic and functional outcomes, with low complication rate and high level of patients’ satisfaction. In transmen who request total phalloplasty after metoidioplasty, all available phalloplasty techniques are feasable.

MP56-13 PATIENT-PERCEIVED CHANGES IN PENILE APPEARANCE POST-URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-13 PATIENT-PERCEIVED CHANGES IN PENILE APPEARANCE POST-URETHROPLASTY Dylan Hoare, Jordan Bekkema, and Keith Rourke Dylan HoareDylan Hoare More articles by this author , Jordan BekkemaJordan Bekkema More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Alterations in penile curvature or length post-urethroplasty are associated with patient dissatisfaction but are poorly described. This study aims to define the incidence and associations of patient-reported penile curvature and shortening after urethroplasty. METHODS: From 2011-2018, 387 patients completed enrollment in a prospective single-centre study assessing patient-reported outcomes pre-operatively and 6-months post-urethroplasty. Primary outcomes of perceived penile shortening and curvature were assessed at 6-months follow-up. Descriptive statistics were used to summarize findings while univariate and multivariate binary logistic regression was used to identify associations between loss of penile length or chordee with other clinical factors. RESULTS: Of the 387 patients, mean age was 49.5 years with mean stricture length of 4.5 cm. Postoperatively, 12.7% of patients perceived penile curvature (8.0% “somewhat”, 4.7% “severe”) and 22.8% of patients perceived penile shortening (14.5% “somewhat”, 8.3% “a lot”). Multivariate binary logistic regression identified stricture location (p=0.02) to be associated with perceived curvature while prior urethroplasty (p=0.17), type of urethroplasty (p=0.08) and other factors were not. Specifically, penile (O.R. 4.27, 95% CI 1.56-11.68, p=0.005) and panurethral (O.R. 10.15, 95% CI 3.46-29.77, p<0.001) locations were independently associated with this outcome. In a multivariate model, panurethral strictures (O.R. 4.23, 95% CI 1.10-16.20, p=0.04) and hypospadias (O.R. 5.46, 95% CI 1.32-22.70, p=0.02) were associated with patient perceived shortening while other factors such as age (p=0.19), type of urethroplasty (p=0.14) and other stricture etiologies or locations were not. CONCLUSIONS: Clinically significant changes in penile appearance are more common post-urethroplasty than initially thought. Stricture location and etiology are important predictors of these patient-perceived changes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e974-e974 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dylan Hoare More articles by this author Jordan Bekkema More articles by this author Keith Rourke More articles by this author Expand All Advertisement Loading ...

MP56-11 REFRACTORY LOWER URINARY TRACT SYMPTOMS (LUTS) FOLLOWING SUCCESSFUL URETHROPLASTY: FURTHER EXAMINING "LUTS FAILURE”

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-11 REFRACTORY LOWER URINARY TRACT SYMPTOMS (LUTS) FOLLOWING SUCCESSFUL URETHROPLASTY: FURTHER EXAMINING "LUTS FAILURE” David Chapman, Jordan Bekkema, and Keith Rourke David ChapmanDavid Chapman More articles by this author , Jordan BekkemaJordan Bekkema More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: An ill-defined proportion of patients undergoing urethroplasty fail to experience improvement in lower urinary tract symptoms (LUTS) despite being stricture-free. We aim to identify the incidence, associations, and causes of “LUTS failure” after urethroplasty. METHODS: Patients undergoing urethroplasty over a 6-year period were offered enrollment in a prospective study examining urinary function after urethroplasty. Patients were assessed pre-operatively and 6-months postoperatively using the international prostate symptom score (IPSS) and cystoscopy. “LUTS failure” was defined as less than 3-point improvement in IPSS, despite an anatomically successful urethroplasty. Multivariable logistic regression was utilized to evaluate the association of several patient factors with “LUTS Failure”. RESULTS: Of 365 patients meeting inclusion criteria, mean postoperative IPSS (20.3 vs. 5.4; p<0.0001) and median urinary quality of life (UQOL)(5 vs. 1; p<0.0001) were significantly improved. Despite being stricture-free, 7.7% of patients reported “LUTS failure” and 10.1% reported UQOL non-response. On multivariable logistic regression, increasing age (O.R.1.04, 95%CI 1.01-1.06, p=0.006) and hypospadias (O.R.18.2, 95%CI 2.1-156.0, p=0.008) were associated with “LUTS failure” while stricture location (p=0.76), length (p=0.14), previous urethroplasty (p=0.96), failed endoscopic treatment (p=0.17), type of urethroplasty (p=0.93) and other etiologies were not. Qualitatively, the most common causes of “LUTS failure” were detrusor underactivity (39.3%), detrusor overactivity (21.4%), pelvic floor dysfunction (21.4%) or BPH (14.3%). Only increasing age was associated with UQOL non-response (O.R.1.03, 95%CI 1.01-1.07, p=0.02). CONCLUSIONS: While many patients experience improved voiding function after urethroplasty, 7.7% experience “LUTS failure” and 10.1% report UQOL non-response. Both occurrences are independently associated with increasing patient age and most commonly related to detrusor underactivity. Source of Funding: Northern Alberta Urology Foundation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e973-e973 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Chapman More articles by this author Jordan Bekkema More articles by this author Keith Rourke More articles by this author Expand All Advertisement Loading ...

Prospective Assessment of Patient-perceived Short-term Changes in Penile Appearance After Urethroplasty

ObjectiveTo define the incidence and associations of patient-reported penile curvature and shortening after urethroplasty. Alterations in penile curvature or length post-urethroplasty are associated with patient dissatisfaction but are poorly described. MethodsFrom 2011 to 2019, 387 patients completed enrollment in a prospective single-centre study assessing patient-reported outcomes pre-operatively and 6-months post-urethroplasty. Primary outcomes of perceived penile shortening and curvature were assessed at 6-months follow-up. Descriptive statistics were used to summarize findings while univariate and multivariate binary logistic regression was used to identify associations between loss of penile length or chordee with other clinical factors. ResultsOf the 387 patients, mean age was 49.5 years with mean stricture length of 4.5 cm. Postoperatively, 12.7% of patients perceived penile curvature (8.0% “somewhat”, 4.7% “severe”) and 22.8% of patients perceived penile shortening (14.5% “somewhat”, 8.3% “a lot”). Multivariate binary logistic regression identified stricture location (P = .02) to be associated with perceived curvature while prior urethroplasty (P = .17), type of urethroplasty (P = .08) and other factors were not. Specifically, penile (O.R. 4.27, 95%CI 1.56-11.68, P = .005) and panurethral (O.R. 10.15, 95%CI 3.46-29.77, P <.001) locations were independently associated with this outcome. In a multivariate model, panurethral strictures (O.R. 4.23, 95%CI 1.10-16.20, P = .04) and hypospadias (O.R. 5.46, 95%CI 1.32-22.70, P = .02) were associated with patient perceived shortening while other factors such as age (P = .19), type of urethroplasty (P = .14) and other etiologies or locations were not. ConclusionClinically significant changes in penile appearance are more common post-urethroplasty than generally thought. Stricture location and etiology are important predictors of these patient-perceived changes.

Urinary Symptom Nonresponse ("LUTS Failure") after Urethroplasty: Incidence and Associations.

An ill-defined proportion of patients undergoing urethroplasty fail to experience improvement in lower urinary tract symptoms (LUTS) despite being stricture-free. We aim to identify the incidence, associations and causes of "LUTS failure" after urethroplasty. Patients undergoing urethroplasty over a 6-year period were offered enrollment in a prospective study examining urinary function after urethroplasty. Patients were assessed preoperatively and 6 months postoperatively using the International Prostate Symptom Score (IPSS) and cystoscopy. "LUTS failure" was defined as ≤3-point improvement in IPSS despite an anatomically successful urethroplasty. Multivariable logistic regression was utilized to evaluate the association between patient factors and "LUTS failure." Of 365 patients meeting inclusion criteria, mean postoperative IPSS (20.3 vs. 5.4, p <0.0001) and median urinary quality of life (UQOL; 5 vs. 1; p <0.0001) were significantly improved. Despite being stricture-free, 7.7% of patients reported "LUTS failure" and 10.1% reported UQOL nonresponse. On multivariable logistic regression, increasing age (OR 1.04, 95% CI 1.01-1.06; p=0.006) and hypospadias (OR 18.2, 95% CI 2.1-156.0; p=0.008) were associated with "LUTS failure," while stricture location (p=0.76), length (p=0.14), previous urethroplasty (p=0.96), failed endoscopic treatment (p=0.17), type of urethroplasty (p=0.93) and other etiologies were not. Qualitatively, the most likely causes of "LUTS failure" were detrusor underactivity (39.3%), overactivity (21.4%), pelvic floor dysfunction (21.4%) or benign prostatic hyperplasia (14.3%). Only increasing age was associated with UQOL nonresponse (OR 1.03, 95% CI 1.01-1.07; p=0.02). While many patients experience improved voiding function after urethroplasty, 7.7% experience "LUTS failure" and 10.1% report UQOL nonresponse. Both occurrences are independently associated with increasing patient age and most commonly related to detrusor underactivity.

Assessing in-hospital morbidity after urethroplasty using the European Association of Urology Quality Criteria for standardized reporting.

To conduct a rigorous assessment of in-hospital morbidity after urethroplasty according with the European Association of Urology (EAU) guidelines for complication reporting. We retrospectively (2015-2019) identified 469 consecutive patients receiving urethroplasty (e.g. bulbar urethroplasty with grafts, penile urethroplasty with/without grafts/flaps, Johanson, de novo or revision perineostomy, end-to-end anastomosis, meatoplasty and/or meatotomy) at our tertiary care institution. Complications were graded with Clavien-Dindo score and Comprehensive Complication Index (CCI). Complications were classified in: bleeding no gastrointestinal, cardiac, gastrointestinal, genitourinary, infectious, neurological, oral, wound, miscellaneous, and pulmonary. Logistic regression tested for predictors of in-hospital complications and prolonged hospitalization (> 75th percentile). Kaplan-Meier and Cox regression investigated the effect of complications on failure after urethroplasty. Overall, 161 (34.3%) patients experienced at least one complication. Of those, 47 (10%) experienced two or more complications and 59 (12.6%) experienced at least one Clavien-Dindo ≥ II complication. Only two patients had Clavien-Dindo III complications. Infectious was the most frequent complication, and de novo or revision perineostomy was associated with the highest rate of complications. The occurrence of any complications, as well as complication with Clavien-Dindo ≥ II were associated with prolonged hospitalizations, but not with higher rates of post-urethroplasty failure. Complications after urethroplasty were common events, but rarely with severe sequelae. Infectious were the most common complications and perineostomy was the type of urethroplasty with the highest rate of complications. The application of the EAU recommendations allowed the identifications of a higher number of complications after urethroplasty if compared with previous reports based on unsupervised chart review.

Preoperative and intraoperative factors predictive of complications and stricture recurrence following multiple urethroplasty techniques

ObjectivesTo investigate factors predictive of postoperative recurrence and complications in patients undergoing urethroplasty for stricture repair at a single center.Patients and methodsWe retrospectively reviewed the records of 108 men who underwent urethroplasty for urethral stricture disease (USD) at a single center from 2016 to 2020. Demographic data, comorbidities, stricture history including etiology and prior treatments, patient‐reported symptoms, and outcomes data were collected for analysis. Data were analyzed in aggregate, then, stratified by type of urethroplasty performed. Descriptive statistics, univariate analysis, multivariate logistic regression, and intergroup comparisons were completed using STATA, with an alpha value of 0.05 and a confidence interval of 95%.ResultsThe median age of our patients was 58 years (interquartile range: 42‐69; range: 29‐83), with a median stricture length of 2.0 cm (interquartile range: 1.0‐4.5; range: 0.5‐10). The most common stricture etiology was iatrogenic (n = 33, 31%) and the most common urethroplasty was anterior anastomotic urethroplasty (n = 38, 35%), followed by buccal mucosal graft (BMG) urethroplasty (n = 35, 32%). Twenty‐four patients (22%) had stricture recurrence. Within the aggregate data, recurrence was significantly predicted by obesity (BMI > 30) (Odds Ratio [OR] 3.2, 95% Confidence Interval [CI]: 1.06‐10), and the presence of postoperative complications (OR 6.3, CI: 1.9‐21). The presence of any postoperative complications within 90 days was significantly predicted by stricture length ≥ 5 cm (OR 3.5, CI 1.09‐12) and recurrence (OR 6.0, CI 1.7‐21).ConclusionDespite serving as the most definitive treatment for urethral stricture management, stricture recurrence and postoperative complications are not uncommon after urethroplasty. Obesity and stricture length negatively impact outcomes while a penile stricture location is associated with a lower recurrence rate, though this is not statistically significant.

Retrospective Study Over the Hypospadias Surgery in a Single Tertiary Center.

Hypospadias surgery is a common activity in every department for pediatric surgery, increased incidence of this condition contributing this aspect. For this purpose permanent review of the data of cases is probably necessary, in order to promptly evaluate short and long term results. Material and methods. The authors are presenting this retrospective clinical and statistical study, enrolling 149 patients, hospitalized and operated in the Department of Pediatric Surgery and Orthopedics, between 2009 and 2018. several parameters were taken into consideration: moment of conception, type of hypospadias, associated malformations, use of meatoplasty, age at meatoplasty, age at urethroplasty, type of urethroplasty, postoperative incidents and complications. Results. Most of the patients included in the study were classified as anterior type of hypospadias, associated malformations were present in 20,13% of the patients, and 80% of the associated malformations belonged to the urogenital system. Over 60% of the cases underwent meatoplasty as a tactical procedure. Mathieu was the most appreciated procedure (74,5%) for urethroplasty and over a half of the patients were operated after the age of 3 years. Early and late postoperative fistula formation was noted in 18,12% of cases. Conclusions. Better parameters to assess the exact type of hypospadias are needed to be introduced. Also, clear protocols for preoperative work-up in detection of other abnormalities, especially genito-urinary. Meatoplasty as a tactical procedure is having unclear influence for urethroplasty. Decreasing the age at urethroplasty should be the next goal. Some surgeons should really get overspecialized for this type of surgery.

The feasibility of urethral plate preservation in proximal and mid-penile hypospadias: sequential and anatomical approach to the repair

BackgroundThe assessment of a child having hypospadias with chordee/ventral curvature (VC) and meatal position that appears to be proximal/mid-penile can be challenging with regard to the choice of chordee correction and type of urethroplasty. The feasibility of preservation of native urethral plate is dependent on these choices. Classically, urethral plate resection of the corpora is performed to correct severe VC, whenever VC is presumed to be due to short urethral plate. But VC is seen to persist in many such cases, in spite of this maneuver that commits the patient to a more complex reconstruction. The aim of the study was to analyze the variation in preoperative and intraoperative assessment of proximal and mid-penile hypospadias, with respect to severity and possible surgical options, in patients treated by a standard protocol of sequential and anatomical approach to repair. The other objective was to ascertain if “extensive ventral urethral detethering” (in all cases) and “urethral plate augmentation” (in select cases) could facilitate more anatomical repair in these cases, with urethral plate preservation and utilization for repair wherever feasible.ResultsFifty-two children who underwent the specific protocol of repair during the 5-year period from January 2014 to December 2018 at a tertiary teaching institution were included in the study. The essential principles adopted for the surgery were as follows: (i) urethral plate preservation in all possible situations; (ii) “extensive ventral urethral detethering” up to the bulb, as a preliminary step, (iii) sequential correction of VC with urethral plate augmentation (in select cases); and (iv) selecting the optimal repair based on the following principles: (a) urethral plate tubularization, (b) urethral plate augmentation, and (c) urethral plate substitution. There was considerable difference in the preoperative and intraoperative assessment of meatal position, with 12 of the apparently mid-penile hypospadias being reclassified as distal penile after preliminary dissection. Three of the penoscrotal variants were regrouped as proximal penile and 6 of the proximal penile were regrouped as mid-penile type. Majority of cases which were deemed to require complex reconstruction on preoperative assessment could be treated by a single-stage procedure.ConclusionThe meatal position is seen to shift distally in select cases of proximal or mid-penile hypospadias after thorough degloving, dartos release, and detethering of Buck’s fascia over ventral urethra. Urethral plate can be preserved for utilization in repair in many of these cases by augmenting the urethral plate, enabling a more anatomical neourethral reconstruction. Resection of urethral plate can be thus restricted to the most severe cases of VC.

Replication of family nurture intervention: Enhancement of autonomic regulation in preterm infants

To determine if age is an independent predictor of surgical success in patients undergoing urethroplasty. Urethroplasty performed by excision and primary anastomosis depends on vascular collateralization. Successful augmented urethroplasty depends on graft neovascularization. Older patients have more comorbid conditions including peripheral vascular disease associated with reduced penile blood flow.This is a retrospective review of urethroplasties from 11 institutions. Primary outcome was functional success at 1 year from surgery, defined as freedom from post-urethroplasty procedures. Secondary outcome was freedom from cystoscopic evidence of stricture recurrence at 3 months. Study outcomes were compared between 2 age cohorts (<60 years old and ≥60 years old). Multivariable logistic regression analysis evaluated the influence of patient factors on our primary and secondary outcomes, using age as a continuous variable.Of 322 urethroplasties, 258 were performed in patients <60 years and 64 in patients ≥60 years. Median follow-up was 1.8 years. The following were not significantly different between groups: stricture length or location, smoking status, number of previous urethrotomies or dilations, and urethroplasty type. The following were more common in patients ≥60 years: diabetes, hypertension, hyperlipidemia, coronary artery and peripheral vascular disease, chronic obstructive pulmonary disease, and cancer. There was no difference in need for repeat procedures or anatomic recurrence between age groups or with increasing age. Stricture length was the only statistically significant clinical factor.Urethroplasty success may be affected by comorbidities but not age. Age alone should not be used as an absolute exclusion criterion for men needing urethral reconstruction.

Measuring stress and allostatic load in Indigenous Australians: A systematic review and analysis of biomarker studies

In this study we aimed to define the prevalence of preoperative and postoperative post-micturition incontinence or post-void dribbling after anterior urethroplasty for urethral stricture disease. We also sought to determine risk factors for its presence.We retrospectively reviewed a prospectively maintained, multi-institutional urethral stricture database to evaluate post-micturition incontinence using a single question from a validated questionnaire, “How often have you had a slight wetting of your pants a few minutes after you had finished urinating and had dressed yourself?” Possible answers were never—0 to all the time—3. The presence of post-micturition incontinence was defined as any answer greater than 0. Comparisons were made to stricture type and location, repair type and patient medical comorbidities.Preoperative and postoperative post-micturition incontinence questionnaires were completed by 614 and 331 patients, respectively. Patients without complete data available were excluded from study. Preoperative post-micturition incontinence was present in 73% of patients, of whom 44% stated that this symptom was present most of the time. Overall postoperative post-micturition incontinence was present in 40% of patients and again it was not predicted by stricture location or urethroplasty type. Of the 331 patients with followup questionnaires 60% reported improvement, 32% reported no change and 8% reported worsening symptoms. The overall rate of de novo post-micturition incontinence was low at 6.3%.The prevalence of preoperative post-micturition incontinence is high and likely under reported. In most patients post-micturition incontinence improves after urethroplasty and the prevalence of de novo post-micturition incontinence is low. The presence of post-micturition incontinence was not predicted by stricture length or location, or urethroplasty repair type.

462 - Urinary symptom non-response (“LUTS failure”) after urethroplasty: Incidence and associations

OBJECTIVE An ill-defined proportion of patients undergoing urethroplasty fail to experience improvement in lower urinary tract symptoms (LUTS) despite being stricture-free. We aim to identify the incidence, associations, and causes of "LUTS failure" after urethroplasty. METHODS Patients undergoing urethroplasty over a 6-year period were offered enrollment in a prospective study examining urinary function after urethroplasty. Patients were assessed pre-operatively and 6-months postoperatively using the international prostate symptom score (IPSS) and cystoscopy. "LUTS failure" was defined ≤3-point improvement in IPSS, despite an anatomically successful urethroplasty. Multivariable logistic regression was utilized to evaluate the association patient factors with "LUTS Failure". RESULTS Of 365 patients meeting inclusion criteria, mean postoperative IPSS (20.3 vs. 5.4; p< 0.0001) and median urinary quality of life (UQOL) (5 vs. 1; p <0.0001) were significantly improved. Despite being stricture-free, 7.7% of patients reported "LUTS failure" and 10.1% reported UQOL non-response. On multivariable logistic regression, increasing age (OR1.04, 95% CI 1.01-1.06, p=0.006) and hypospadias (OR18.2, 95% CI 2.1-156.0, p=0.008) were associated with "LUTS failure" while stricture location (p=0.76), length (p=0.14), previous urethroplasty (p=0.96), failed endoscopic treatment (p=0.17), type of urethroplasty (p=0.93) and other etiologies were not. Qualitatively, the most likely causes of "LUTS failure" were detrusor underactivity (39.3%), overactivity (21.4%), pelvic floor dysfunction (21.4%) or BPH (14.3%). Only increasing age was associated with UQOL non-response (OR1.03, 95% CI 1.01-1.07, p=0.02). CONCLUSION While many patients experience improved voiding function after urethroplasty, 7.7% experience "LUTS failure" and 10.1% report UQOL non-response. Both occurrences are independently associated with increasing patient age and most commonly related to detrusor underactivity.

Development and Validation of A Male Anterior Urethral Stricture Classification System

To develop and validate a clinical classification system for urethral stricture disease (USD) based on the retrograde urethrogram (RUG), physical exam, and stricture-specific patient history. Three elements were chosen to be included in the classification system: 1) Length of urethral stricture (L); 2) Stricture segment/location (S); 3) Stricture Etiology (E) (LSE classification system). Each element was divided into clinically relevant sub-categories. A three-step development and validation process then ensued, culminating in an in-person Trauma and Urologic Reconstruction Network of Surgeons (TURNS) meeting, at which the final classification system was unanimously agreed upon by attendees based on interrater reliability data obtained from the classifying of 22 clinical vignettes. A final validation step involved retrospectively classifying cases in the TURNS database to determine if classification influenced surgical technique and was associated with presumed stricture etiology. The final LSE classification system was found to have an interrater reliability of 0.79 (individual components 0.76, 0.70 and 0.93 respectfully). Retrospective classification of the 2162 TURNS strictures revealed the segment (S) to be strongly associated with urethroplasty type (p = 0.0005) and stricture etiology (E) (p = 0.0005). We developed and validated a novel, easy to use, urethral stricture classification system. The system's ability to aid in directing treatments, predict treatment outcomes, and facilitate collaborative research efforts will require further study.

Efficacy of revision urethroplasty in the treatment of recurrent urethral strictures at a tertiary hospital (Kenyatta National Hospital–KNH), in Nairobi Kenya: 2015-2018

Background: Urethral strictures cause malfunction of the urethra. Urethroplasty is a cost-effective treatment option. Its success rate is greater than 90% where excision and primary anastomosis(EPA)is performed and 80-85% following substitution urethroplasty. Definitive treatment for recurrent urethral strictures after urethroplasty is not defined. Repeat urethroplasty is a viable option with unknown efficacy.Method: Retrospective analysis of patients who underwent revision urethroplasty for unsuccessful urethroplasty at KNH from 2015 to 2018 was performed. Patients’ age, demographic data, stricture length, location, aetiology, comorbidities and type of urethroplasty was evaluated from records with complete data. Male patients aged 13 to 80years were evaluated. Comparison of urethroplasty outcome between two patient cohorts was made: Fresh urethroplasty patients versus failed urethroplasty who underwent revision so as to determine efficacy of the later. Principal outcome measure was urethral patency, while Subsidiary outcome measures were associated complications. Outcomes were compared using statistical package SPSS version 23.0.Result: 235 patients who met inclusion criteria underwent urethroplasty, 71.5% (n=168) had a successful outcome, while28.5% (n=67) failed and were subjected to revision urethroplasty. Another 58% were successful upon revision but experienced significant morbidity. Majority of urethral strictures were bulbomembranous. Trauma was the leading cause of urethral strictures followed by idiopathic strictures. EPA was the commonest surgery while Tissue transfer featured prominently in revision urethroplasty. A significant correlation was evident between stricture length, prior surgery, and procedure choice and urethroplasty outcome.Conclusion: Revision urethroplasty is feasible after failed urethroplasty but less efficacious. Stricture length, number of prior surgeries and procedure choice affected outcome.EPA and Tissue Transfer techniques are essential surgical armamentarium in revision setting.