Urethrotomy Research Articles

Comparison of perineal urethrostomy versus augmentation urethroplasty in anterior urethral stricture disease.

Perineal urethrostomy and urethroplasty are very good options for complex and long anterior urethral strictures. A perineal urethroplasty is usually a neglected option. To our knowledge, a comparative study between augmentation urethroplasty and perineal urethrostomy has been not conducted regarding subjective and patient reported outcome measures. We compared both these groups in a high volume tertiary care hospital. A prospective comparative study of augmentation urethroplasty and perineal urethroplasty for long anterior urethral stricture. it was defined by strictures of more than 3 cm. We compared demographic data, urinary and sexual function; and quality of life using validated PROMs (patient-reported outcome measures) between both above groups. Both groups had 40 patients each. IPSS score improvement for PU and AUP were 20 and 19.6, respectively(p = 0.1223); IIEF-5 score improvement for PU and AUP at baseline and after 6 months were 14.3 and 16.7, respectively(p = 0.1433); QOL score improvement for PU and AUP were 3.45 and 3.05, respectively; which was statistically significant (p ⩽ 0.001). Perineal urethrostomy is a good but neglected option for complex and long anterior urethral strictures and it should be considered one of the reliable treatment option for patients with long-segment urethral strictures.

Perineal urethrostomy in a ferret (Mustela putorius furo) to treat iatrogenic urethral stricture after orchiectomy

AbstractA 5‐month‐old ferret (Mustela putorius furo) was presented with a recent history of stranguria, distended urinary bladder, post‐renal azotaemia and a severed urethra following orchiectomy at the referring practice 4 weeks previously. At presentation, an indwelling urinary catheter was present, and the general examination was unremarkable. Blood analyses showed increased serum urea levels. An abdominal ultrasound showed no abnormalities. Contrast cystourethrography revealed a urethral stricture at the level of the castration site. Perineal urethrostomy was performed proximal to the stenosis, caudal to the pubis bone. Examination of the stoma 3 weeks postoperatively showed good healing and no stenosis. No recurrence of signs was reported at regular follow‐up phone communication with the owner up to 11 months postoperatively. Urethral stricture is a possible complication following orchiectomy in ferrets, and a perineal urethrostomy can be performed.

Feasibility and Outcomes of Temporary Bulbar Urethral Stent Placement After Internal Urethrotomy in the Largest Multicenter Series

BackgroundRecent years have seen the development of a new generation of temporary urethral stents as an adjuvant option after direct vision internal urethrotomy (DVIU). Despite some early promising results, large series addressing their safety and outcomes are still lacking. ObjectiveTo report complications and outcomes from the largest series of patients receiving a temporary bulbar urethral stent to date. Design, setting, and participantsWe performed a retrospective analysis of bulbar urethral stenting procedures after DVIU in seven centers. Patients either refused urethroplasty or were not fit for surgery. The stents were removed after at least 6 mo in place unless complications requiring earlier removal occurred. Surgical procedureDVIU with a cold knife or laser is performed, followed by stent placement. At the end of the treatment period, the stent is removed under cystoscopy with gripping forceps. MeasurementsAll patients underwent postoperative follow-up (FU) for assessment of complications while the stent was in place. After removal, the FU schedule consisted of office evaluation at 6 mo and 12 mo, and then annually. Failure was defined as any treatment for urethral stricture after stent removal. Results and limitationsA total of 49% of the patients experienced complications. The most frequent were discomfort (23.8%), stress incontinence (17.5%), and stent dislocation (9.8%). Some 85% of the adverse events observed were Clavien-Dindo grade <3. The overall success rate at median FU of 38.2 mo was 76.9%. The success rate was significantly lower if the stent was removed before 6 mo (53.3% vs 79.7%; p = 0.026). ConclusionsTemporary urethral stents may be a safe choice with satisfactory results in patients not undergoing urethroplasty. A stent indwelling time shorter than 6 mo provides worse outcomes that are comparable to those with DVIU alone. Patient summaryWe assessed complications and outcomes after placement of a temporary narrow tube in the urethra after surgery to widen a narrowing of the urethra. The treatment is safe and easily reproducible with satisfactory results. Further studies are needed to confirm our findings.

(434) Value of Office Pre-Operative Cystoscopy Prior to Penile Prosthesis Surgery

Abstract Introduction Discovery of obstructive urethral pathology, such as urethral stricture, benign prostatic hyperplasia (BPH), or bladder neck contracture (BNC), during inflatable penile prosthesis (IPP) placement may result in aborted prosthetic implantation. Routine pre-operative office cystoscopy to evaluate for obstructive urethral pathology would likely prevent aborted implant cases. However, routine cystoscopy would also represent a substantial cost to the patient and healthcare system, especially since urethral pathology resulting in aborted cases is anecdotally rare. Objective Our objective was to evaluate the incidence of unexpected obstructive urethral pathology resulting in aborted IPP cases and then compare the cost of aborted cases to the cost of routine pre-operative office cystoscopy for all planned implants. Methods We retrospectively evaluated completed and aborted IPP placements by a high-volume surgeon from 1/1/2014 through 5/23/2022 for both virgin (CPT 54405) and revision (54410) IPPs, with further selected assessment of cases with concomitant cystoscopy (52000), urethral dilation (52281), and direct vision internal urethrotomy (55276). Selected cases were reviewed for additional patient information including prior urologic surgery, pelvic radiation, and clinical information regarding intra-operative cystoscopy. Cost analysis was conducted for office cystoscopy and operative costs associated with IPP cases based on institutional cost data. Outcomes evaluated included incidence of unexpected obstructive urethral pathology requiring aborted IPP placement, break-even points for office cystoscopy compared to cost of aborted IPP cases, and ‘number needed to scope’ to avoid an aborted implant. Results From a total of 822 IPP cases performed, 17 (2.1%) had concomitant cystoscopy, of which 11 (1.3%) were unplanned. Nine cystoscopies (1.1%) resulted from inability to place a urethral catheter secondary to urethral stricture (n=5), BNC (n=2), BPH (n=1), and no identifiable pathology (n=1). Three IPPs (0.4%) were aborted due to dense urethral stricture at a total cost of $42,982, with ‘number need to scope’ of 274 to avoid an aborted implant. With total calculated cost for office cystoscopy for all planned IPPs of $164,498 ($200.12 per patient), the rate of aborted IPP due to urethral pathology would need to exceed 1.4% to make routine office cystoscopy cost saving (Figure 1). Alternatively, at the observed incidence of aborted IPP (0.4%), routine office cystoscopy would need to cost $50.50 to break-even with the cost of aborted IPPs. Conclusions Unexpected obstructive urethral pathology resulting in aborted IPP is rare. As a result, routine pre-operative office cystoscopy for asymptomatic men prior to IPP does not provide cost savings at our institution. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Dr. Aaron Lentz is a speaker, preceptor, and consultant for Boston Scientific and Coloplast. Dr. Faysal Yafi is a speaker, advisor and consultant for Coloplast, Antares Pharma, Clarus Therapeutics, Promescent, Acerus, Sprout and Cynosure.

(339) Urologic and Psychiatric Considerations in Male Genital Self-Mutilation

Abstract Introduction Male genital self-mutilation (GSM) can be categorized into four subtypes – amputation, castration, mutilation, and combined amputation/castration. The most common psychiatric diagnosis associated with GSM is schizophrenia, followed by substance use disorders, personality disorders and gender dysphoria. Objective We discuss a case of amputation/castration GSM in a patient presenting without his severed organ. Treatment considerations in patients with active psychosis due to schizophrenia presenting with GSM are discussed. Methods A 30-year-old single male with a history of schizophrenia requiring multiple prior inpatient psychiatric admissions, obsessive compulsive disorder, and autism spectrum disorder presented to the Emergency Department with penile and bilateral testicular self-amputation. Upon inquiry regarding the method of injury, the patient stated “someone” instructed him to “cut off” his penis and testes with a pair of scissors. He subsequently disposed of his severed organs by flushing them down the toilet. Consent was obtained from the patient’s mother, who served as his healthcare proxy. He underwent operative intervention including penile “stump-plasty”, suture ligation of the bilateral spermatic cords, and scrotal Penrose drain placement with loose re-approximation of scrotal skin. He was admitted for inpatient psychiatric care for management of schizophrenia with active psychosis. Post-operatively he was observed repeatedly touching and contaminating his surgical site and developed a wound infection. The patient underwent operative wound exploration and washout on post-operative day 10. He convalesced well after completing a course of antibiotics for MRSA wound infection. Results Operative intervention options in patients presenting with GSM differ based on the presence or absence of the severed penis. In this patient who presented without the severed penis, possible operative intervention includes primary closure with urethral advancement (stump-plasty), debridement and delayed repair with skin grafting, and perineal urethrostomy. Our patient underwent stump-plasty, and was able to void while standing in the post-operative period. Penile replantation can be considered when the organ has not been discarded. Considerations in psychiatric patients presenting with self-inflicted injuries secondary to a psychotic episode include the patient’s ability to provide informed consent, insight into the patient’s condition, history and severity of mental illness, and increased likelihood of future attempts at self-harm. Severe schizophrenia is associated with increased perioperative complications, including sepsis, acute kidney injury, increased length of stay, and operative wound infections, as well as increased odds of having an adverse operative outcome. Risk factors for GSM include psychotic experiences, personality disorders, prior history of GSM, alcohol and drug use, guilt toward sexual feelings, and early father loss. Patients presenting with an acute episode of psychosis and GSM have increased risk of future GSM, with up to one-third of these patients making a repeated attempt at GSM. Conclusions In a patient with GSM who presents without the severed organ, the physician should consider the patient’s psychiatric history. In patients with an acute psychotic episode and severe schizophrenia, physicians should consider primary closure with urethral advancement versus perineal urethrostomy rather than delayed repair with skin grafting to avoid the risk of wound infection. Disclosure No

(544) Incidental Findings of Pre-Operative Cystoscopy Procedure prior to IPP

Abstract Introduction Inflatable Penile Prosthesis (IPP) is a common treatment modality for Erectile Dysfunction (ED). Previous studies have advocated the importance of undergoing a cystoscopy prior to an IPP procedure and whether the costs outweigh the benefits. Cystoscopies assist in diagnosing Lower Urinary Tract Obstructions (LUTO) such as BPH with obstruction, urethral strictures, bladder stones, and bladder tumors. These pathologies can cause complications in patients who undergo IPP, as well as unnecessary costs for canceling or aborting surgery. Due to these risks, cystoscopies may be a necessary pre-operative procedure prior to implantation. However, cystoscopies can be costly and there is an increased risk of infection. As a result, the cost-benefit analysis of performing this procedure in patients prior to IPP placement remains controversial. Objective To evaluate the prevalence of incidental findings found during cystoscopy, to determine if this procedure should be routinely implemented in clinical practice prior to IPP placement Methods We performed a retrospective study which identified all patients undergoing “de novo” IPP surgery, performed from May 2019 until May 2022, by two high volume implant surgeons. A review of all patients who underwent direct vision internal urethrotomy, or cystoscopy procedure prior to surgery was performed. The study population consists of men who underwent cystoscopy procedure prior to inflatable penile prosthesis (IPP) surgery in the office setting. Only patients who had no previous history of penile implantation were included. All clinical notes, patient demographics, comorbidities and surgical outcomes were reviewed. Results 224 patients met the inclusion criteria. Of the 224 patients who underwent cystoscopy, prior to implantation, 153 (68%) had no previous history of cystoscopy procedure, while 28 (12%) had prior robotic assisted laparoscopic prostatectomy (RALP). This cohort consisted of 40 (18%) patients whose cystoscopy findings lead to other urological procedures prior to IPP surgery. These findings included 15 patients with bladder outlet obstruction due to BPH, which required a TURP, 18 patients with previously unknown bladder tumors, which required a TURBT, and 7 patients with bladder stones which required cystolithotomy. Other incidental findings which did not require surgery included 24 (11%) patients found to have urethral strictures treated with traditional urethral dilation, with only 3 requiring cold knife therapy. 27 patients diagnosed with prostatic strictures secondary to previous prostatic procedures including TURP, Urolift, Microwave Therapy, cryotherapy, etc. These patients were dilated with the scope at the time of procedure. There were 3 patients that presented with kidney stones in the bladder which did not require additional procedures. Of this cohort, 8 (3.5%) patients had post-procedural infections that were treated with a conservative course of antibiotics and did not require further treatment. Conclusions In patients with no previous history of urologic evaluation, a pre-operative cystoscopy procedure can be an invaluable tool to help prevent unnecessary complications or misdiagnosed pathology, such as bladder cancer or urethral strictures. Unplanned intraoperative cystoscopies and interventions can be costly and may be avoided with a simple in office cystoscopy prior to penile implantation. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific

Cutaneous Radiation-Associated Angiosarcoma After Treatment of Carcinoma Penis: First Report from Tertiary Cancer Centre of North India.

Cutaneous radiation-associated angiosarcoma (cRAA) is a rare and aggressive secondary cutaneous angiosarcoma (cAS) with poor survival. cRAA has been mostly reported in breast carcinoma patients. Owing to its rarity, there is scanty literature available and no treatment guidelines. To the best of our knowledge, this is the first report of cRAA after multimodality treatment of carcinoma penis. A sixty-eight-year-old gentleman, a known case of carcinoma penis, underwent total penectomy with perineal urethrostomy and bilateral radical inguinopelvic lymph node dissection 6 years ago. He received adjuvant radiotherapy to the pelvis and bilateral groin. He presented with a bleeding plaque-like lesion with ulceration over the left lower abdomen (within previous radiation field) which rapidly progressed in size over the past 2 months. On examination, the lesion bled profusely on touch. Contrast MRI was suggestive of lobulated exophytic enhancing cutaneous lesion free from underlying muscle. Wedge biopsy was suggestive of cutaneous angiosarcoma. He underwent wide local excision with local perforator flap reconstruction from the right lower abdomen. Histopathology was suggestive of cutaneous angiosarcoma which showed immunoexpression of CD31, ERG1, cMYC suggestive of cRAA. cRAA is a very aggressive disease with 5-year survival of15-34%. To the best of our knowledge, this is the first ever reported case of cRAA of lower abdomen after multimodality management of carcinoma penis. It masquerades with other benign and less aggressive radiation-induced skin lesions. cMYC immunoexpression is specific for secondary cAS. Wide local resection with negative margin provides the best outcome.

Outcome of preputioplasty in cats with acquired phimosis: Eight cases

Preputioplasty is a surgical procedure performed to increase the orifice diameter and phimosis, which is defined by the inability of the penis to extrude due to the absence or restriction of the preputial opening, is uncommon in cats. A total of eight male cats were referred to Ataturk University Veterinary Faculty Animal Hospital due to the complaint of difficulty in urination and prolonged sitting in the litter box. Narrowed preputial opening and abdominal distension were noted in all cats. The penis was too stenotic to be extruded from the preputial orifice, and urine accumulated in the preputial cavity. The serum biochemistry and hemogram results of cats were within the reference values. After the clinical examination, acquired phimosis was diagnosed. The scar tissues around the preputial orifice that prevented the extrusion of the penis were resected surgically (preputioplasty). Normal urination was recorded following preputioplasty in all cases. In one case, recurrence was postoperatively detected on the 30th day and perineal urethrostomy was performed. Preputioplasty to enlarge the preputial orifice may be used to treat acquired phimosis in cat with a low rate complication.

Risk factors for bladder neck contracture after transurethral resection of the prostate.

Transurethral resection of the prostate (TURP) is the most frequently used treatment of benign prostate hyperplasia with a prostate volume of <80 mL. A long-term complication is bladder neck contracture (BNC). The aim of the present study was to identify the risk factors for BNC formation after TURP. We conducted a retrospective analysis of all TURP primary procedures which were performed at one academic institution between 2013 and 2018. All patients were analyzed and compared with regard to postoperative formation of a BNC requiring further therapy. Uni- and multivariable logistic regression analyses (MVAs) were performed to identify possible risk factors for BNC development. We included 1368 patients in this analysis. Out of these, 88 patients (6.4%) developed BNC requiring further surgical therapy. The following factors showed a statistically significant association with BNC development: smaller preoperative prostate volume (p = 0.001), lower resected prostate weight (p = 0.004), lower preoperative levels of prostate-specific antigen (PSA, p < 0.001), shorter duration of the surgery (p = 0.027), secondary transurethral intervention (due to urinary retention or gross hematuria) during inpatient stay (p = 0.018), positive (≥100 CFU/mL) preoperative urine culture (p = 0.010), and urethral stricture (US) formation requiring direct visual internal urethrotomy (DVIU) postoperatively after TURP (p < 0.001), in particular membranous (p = 0.046) and bulbar (p < 0.001) strictures. Preoperative antibiotic treatment showed a protective effect (p = 0.042). Histopathological findings of prostate cancer (PCA) in the resected prostate tissue were more frequent among patients who did not develop BNC (p = 0.049). On MVA, smaller preoperative prostate volume (p = 0.046), positive preoperative urine culture (p = 0.021), and US requiring DVIU after TURP (p < 0.001) were identified as independent predictors for BNC development. BNC is a relevant long-term complication after TURP. In particular, patients with a smaller prostate should be thoroughly informed about this complication.

Male Urethral Stricture in Patients with Metabolic Syndrome.

Urethral stricture is characterized by fibrosis that decreases urine flow. Metabolic syndrome is a complex disorder that causes fibrosis in many organs. This study aimed to evaluate the relationship between metabolic syndrome and appearance of urethral stricture and effects of metabolic syndrome on the recurrence of urethral stricture in patients with primary urethral stricture who underwent direct visual internal urethrotomy. One hundred thirty-two male patients who underwent direct visual internal urethrotomy between 2014 and 2021 because of primary urethral stricture were included. Location, length, and type of urethral stricture, time from diagnosis to surgery, postoperative follow-up, time from surgery to recurrence, and postoperative follow-up duration with a urethral catheter were retrospectively analyzed and association with metabolic syndrome was evaluated. The mean age was 50.48 ± 17.94 years. Recurrence was found in 34.1% and metabolic syndrome in 27.3%. Postoperative follow-up duration was significantly longer in patients with recurrence than in those without (P=.033). There was no statistically significant difference in terms of metabolic syndrome and postoperative urethral catheterization between patients with and without recurrence (P=.126, P=.714, respectively). Postoperative clean intermittent self-catheterization use was found to be statistically higher in patients with recurrence than in patients without recurrence (P=.018). Postoperative urinary tract infection rate was found to be significantly higher in patients with metabolic syndrome compared to patients without metabolic syndrome (P=.001). Metabolic syndrome was not associated with recurrence. However, postoperative urinary tract infections were more common in patients with metabolic syndrome than in patients without. Clean intermittent self-catheterization used postoperatively may increase the risk of stricture.

MP78-09 SALVAGE DIRECT VISION INTERNAL URETHROTOMY FOR AFTER FAILED SUBSTITUTION URETHROPLASTY: EXTENDED LONG-TERM FOLLOW-UP FROM A RECONSTRUCTIVE REFERRAL CENTER

You have accessJournal of UrologyCME1 Apr 2023MP78-09 SALVAGE DIRECT VISION INTERNAL URETHROTOMY FOR AFTER FAILED SUBSTITUTION URETHROPLASTY: EXTENDED LONG-TERM FOLLOW-UP FROM A RECONSTRUCTIVE REFERRAL CENTER Dejan K. Filipas, Roland Dahlem, Phillip Marks, Tim A. Ludwig, Silke Riechardt, Margit Fisch, and Malte W. Vetterlein Dejan K. FilipasDejan K. Filipas More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Phillip MarksPhillip Marks More articles by this author , Tim A. LudwigTim A. Ludwig More articles by this author , Silke RiechardtSilke Riechardt More articles by this author , Margit FischMargit Fisch More articles by this author , and Malte W. VetterleinMalte W. Vetterlein More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is controversy regarding the optimal salvage treatment option for stricture recurrence after anterior buccal mucosal graft urethroplasty (BMGU). Data on retreatment modalities and their outcomes are scarce. Thus, we aimed to report on our extended follow-up of patients undergoing direct vision internal urethrotomy (DVIU) for short, veil-like recurrences after anterior BMGU. METHODS: We included all men undergoing salvage DVIU for recurrence with short segment, anastomotic fibrous rings after prior BMGU at our center between 2009-2021. We recorded clinical characteristics such as stricture location relative to the buccal graft (proximal, middle, distal), time from BMGU to DVIU in months, and etiology. Primary endpoint was retreatment-free survival after salvage DVIU. Kaplan-Meier analysis was performed for censoring and subsequent treatment modalities in the case of recurrence after salvage DVIU were extracted. RESULTS: Overall, 105 patients underwent DVIU after BMGU for bulbar (66%), penobulbar (16%), penile (15%), or membranous stricture (2.9%). 45% of strictures were proximal of the graft, 43% distal, and 12% were located in a middle position or both proximal and distal of the graft. The majority of strictures were iatrogenic (67%), followed by idiopathic (13%), inflammatory (9.6%), and posttraumatic etiology (7.7%). Median time from BMGU to salvage DVIU was 10 mo (IQR 4.2-28). 13 men (12%) were lost to follow-up and at a median follow-up of 74 mo (IQR 32-127), 53 men (58%) suffered from stricture recurrence (median time to recurrence: 15 mo [IQR 5.0-41]). 12-mo retreatment-free survival was 86%, 82%, and 70% for proximal, distal, and middle/both proximal+distal stricture position, respectively (p=0.1; Figure 1). In patients recurring after salvage DVIU, most subsequent interventions consisted of redo BMGU (46%) and redo salvage DVIU (31%). CONCLUSIONS: Salvage DVIU for veil-like, short segment recurrences remains a limited but viable endoscopic treatment option after anterior BMGU. Pending larger multi-institutional validation, the benefit of DVIU appears more pronounced for anastomotic rings developing at the distal edge of the buccal graft. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1135 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dejan K. Filipas More articles by this author Roland Dahlem More articles by this author Phillip Marks More articles by this author Tim A. Ludwig More articles by this author Silke Riechardt More articles by this author Margit Fisch More articles by this author Malte W. Vetterlein More articles by this author Expand All Advertisement PDF downloadLoading ...

MP78-01 EFFECT OF URETHRAL STRICTURE AUA GUIDELINES ON NATIONAL TRENDS IN RECONSTRUCTIVE MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023MP78-01 EFFECT OF URETHRAL STRICTURE AUA GUIDELINES ON NATIONAL TRENDS IN RECONSTRUCTIVE MANAGEMENT Samuel Sorkhi, Sirpi Nackeeran, Michael Witthaus, Jill Buckley, and M. Raj Rajasekaran Samuel SorkhiSamuel Sorkhi More articles by this author , Sirpi NackeeranSirpi Nackeeran More articles by this author , Michael WitthausMichael Witthaus More articles by this author , Jill BuckleyJill Buckley More articles by this author , and M. Raj RajasekaranM. Raj Rajasekaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral Stricture Disease (USD) is a pathological narrowing of the urethra that often results in lower urinary tract symptoms (LUTS), urinary incontinence, urinary tract infections, and ultimately progression toward acute urinary retention. In 2016, the AUA released guidelines on urethral stricture management, focusing on the importance of an earlier transition to urethroplasty rather than repeat endoscopic procedures. This study aims to analyze the recent trends in male urethral stricture treatment from 2016-2020 to determine the impact of the AUA’s most recent guidelines on male urethral stricture management. METHODS: We utilized electronic health record data stored within the TriNetX Research Network to conduct a retrospective analysis of procedures performed between 2016-2020 (a total of 78,532 procedures). Rates of direct visual internal urethrotomy (DVIU), urethral dilation, dilation+DVIU, and urethroplasty were analyzed using chi-square analysis to assess linear trends. RESULTS: The dilation+DVIU group showed a significant increase in procedure rates between 2016-2017 (p=1.269E-08), 2016-2018 (p=5.08E-07), 2016-2019 (p=2.7637E-31), and 2018-2019 (p=5.38E-13; Figure 1A-B). While 2019-2020 showed a decrease (p=4.792E-06), an analysis of the overall trend from 2016-2020 demonstrated no significant difference (p=0.07739). Urethroplasty was offered to younger patients when compared to urethral dilation/incision (Figure 1C) performed in older patients. Repeat dilation/incisions were performed at significantly (22%) higher rates when compared to urethroplasty (Figure 1D). CONCLUSIONS: Despite AUA recommendations encouraging reconstructive surgeons to offer urethroplasty instead of repeated endoscopic interventions, our results suggest no significant change in the rates of these procedures after the release of the 2016 AUA urethral stricture guidelines. The lack of clinical modification may reflect the lag-time incorporating guideline recommendations or practice barriers to implementation. Source of Funding: UCSD Academic Senate © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1131 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Sorkhi More articles by this author Sirpi Nackeeran More articles by this author Michael Witthaus More articles by this author Jill Buckley More articles by this author M. Raj Rajasekaran More articles by this author Expand All Advertisement PDF downloadLoading ...

PD35-12 MULTI-INSTITUTIONAL ANALYSIS OF SURGERY FOR LICHEN SCLEROSUS INDUCED PENILE URETHRAL STRICTURES: CONFIRMING SINGLE-STAGE URETHROPLASTY AS THE TREATMENT STANDARD

You have accessJournal of UrologyCME1 Apr 2023PD35-12 MULTI-INSTITUTIONAL ANALYSIS OF SURGERY FOR LICHEN SCLEROSUS INDUCED PENILE URETHRAL STRICTURES: CONFIRMING SINGLE-STAGE URETHROPLASTY AS THE TREATMENT STANDARD Ross Hengel, Alex Vanni, Bradley A Erickson, Sean Elliott, Benjamin Breyer, Jill C Buckley, Joshua Broghammer, Bryan Voelzke, Jeremy B Myers, Nathan Hoy, and Keith Rourke Ross HengelRoss Hengel More articles by this author , Alex VanniAlex Vanni More articles by this author , Bradley A EricksonBradley A Erickson More articles by this author , Sean ElliottSean Elliott More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Jill C BuckleyJill C Buckley More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Jeremy B MyersJeremy B Myers More articles by this author , Nathan HoyNathan Hoy More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal treatment of penile urethral strictures related to lichen sclerosus (LS) is controversial. At the heart of the debate lies the issue of whether or not a single-stage reconstruction should be employed over a 2-stage repair to minimize the number of surgeries performed. Additionally, depending on patient preference, a urethrostomy is a viable option. The objective of this study is to compare single-stage urethroplasty, staged urethroplasty and perineal urethrostomy for the treatment of LS related penile urethral strictures in a multi-institutional analysis. METHODS: A retrospective analysis was performed on patients undergoing urethroplasty for LS induced isolated penile urethral strictures (LSE S2b/S2c) at 9 different institutions. Meatal strictures <2 cm in length and panurethral strictures (>10 cm) involving the bulbar urethra were excluded from study. Patients were reconstructed using either a single-stage approach, a staged technique or perineal urethrostomy. The primary outcome measure was urethral patency at routine follow-up cystoscopy without stricture intervention thereafter and secondary outcomes were 90-day complications, and adverse change in sexual dysfunction, chordee or urethrocutaneous fistula. Outcomes were compared using a Cox regression or a two-tailed Chi-square test when appropriate. RESULTS: 231 patients were analyzed with an average age of 51.6 years and mean stricture length of 5.5 cm. Prior endoscopic treatments were performed in 197 patients (85.3%) with a mean of 3.0 prior endoscopic treatment attempts. Overall, 127 (55.0%) were managed with single-stage BMG urethroplasty, 44 (19.0%) with staged BMG, and 60 (26.0%) with perineal urethrostomy. At a mean follow-up of 68.6 months, overall stricture free rate was 81.0% (n=187). Clavien ≥2 90-day complications occurred in 17 patients (9.8%). de novo erectile dysfunction occurred in 13 patients (5.6%), chordee in 7 (4.8%), and urethrocutaneous fistula in 3 (3.4%). On Mantel-Cox testing, there was no difference in stricture recurrence between techniques (15.7% vs. 27.3% vs. 20.0%; p=0.60) and no difference in 90-day complications (8.0% vs. 15.6% vs. 9.8%; p=0.45), erectile dysfunction (7.1% vs. 4.5% vs. 3.3%; p=0.55), chordee (6.7% vs. 0.0% vs. 3.6%; p=0.33), and urethrocutaneous fistula (2.2% vs. 9.1% vs. 0.0%; p=0. 0.17). On Cox regression analysis, obesity (BMI>35) was associated with a higher rate of stricture recurrence (Hazard Ratio 2.31, 95%CI 1.28-4.17, p=0.006, 30.1% vs. 13.9%) but not 90-day complications (Odds Ratio 1.00, 95% CI 0.33-2.99, p=0.99, 9.8% vs. 9.8%). No other clinical variable was associated with stricture recurrence or 90-day complications. CONCLUSIONS: Favorable outcomes of single-stage techniques for the treatment of lichen sclerosus induced penile urethral strictures, confirm single-stage urethroplasty as the treatment standard for LS induced penile urethral strictures especially when considering the decreased number of surgeries the patient is exposed to. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e979 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ross Hengel More articles by this author Alex Vanni More articles by this author Bradley A Erickson More articles by this author Sean Elliott More articles by this author Benjamin Breyer More articles by this author Jill C Buckley More articles by this author Joshua Broghammer More articles by this author Bryan Voelzke More articles by this author Jeremy B Myers More articles by this author Nathan Hoy More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...

MP78-08 OUTCOMES OF URETHROPLASTY FOR SYNCHRONOUS ANTERIOR URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP78-08 OUTCOMES OF URETHROPLASTY FOR SYNCHRONOUS ANTERIOR URETHRAL STRICTURE Marcus Jamil, Alexandra Hansma, Nejd Alsikafi, Benjamin Breyer, Joshua Broghammer, Jill Buckley, Sean Elliott, Bradley Erickson, Jeremy Meyers, Andrew Peterson, Keith Rourke, Thomas Smith, Bryan Voelzke, Lee Zhao, and Alex Vanni Marcus JamilMarcus Jamil More articles by this author , Alexandra HansmaAlexandra Hansma More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Jill BuckleyJill Buckley More articles by this author , Sean ElliottSean Elliott More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Jeremy MeyersJeremy Meyers More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Keith RourkeKeith Rourke More articles by this author , Thomas SmithThomas Smith More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Lee ZhaoLee Zhao More articles by this author , and Alex VanniAlex Vanni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of male anterior urethral stricture disease (USD) has been well described. Less is known regarding the management strategies and outcomes in patients with synchronous USD (SUSD). SUSD is the presence of two distinct urethral strictures separated by a healthy intervening urethral segment. This study sought to assess the functional outcomes following repair of SUSD. METHODS: Patients with documented SUSD within a multi-institutional database were retrospectively assessed and compared to patients with solitary USD. Patients who underwent single-stage or staged anterior urethroplasty, including meatoplasty and perineal urethrostomy were included. Patients with a posterior urethral stricture or bladder neck involvement were excluded. Stricture classification according to the LSE (Length, Urethral Segment, Etiology) was performed. Stricture recurrence between cohorts was assessed, defined as undergoing repeat treatment. Logistic regression was performed to assess predictors of failure. RESULTS: 168 of the 2,299 patients had SUSD (7.3%). Patients with SUSD had a significantly shorter mean primary stricture length than those with solitary USD, 3.6 cm vs. 4.7 cm, p<0.001. Mean stricture length for the secondary stricture was 2.6 cm. Patients with SUSD had a larger proportion of strictures classified as S2b, S2c and S2d than in those with solitary USD (p<0.001). Patients with SUSD were more likely to be due to Lichen Sclerosus (LS) or hypospadias (Table 1). On univariate analysis, SUSD had a higher stricture retreatment rate, 8.0% vs. 13.1%, p=0.02. On multivariable analysis, SUSD was not associated with higher retreatment rates, OR 1.37 (0.79–2.28), p=0.2. Patients with SUSD and stage S1a, S1b, S2c, S2d and S3 stricture location demonstrated higher rates of stricture recurrence than controls (Table 2). CONCLUSIONS: Patients with SUSD have higher rates of stricture recurrence following urethroplasty compared to patients with solitary USD on univariate analysis. Patients with LS and hypospadias are more likely to have SUSD. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1134 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcus Jamil More articles by this author Alexandra Hansma More articles by this author Nejd Alsikafi More articles by this author Benjamin Breyer More articles by this author Joshua Broghammer More articles by this author Jill Buckley More articles by this author Sean Elliott More articles by this author Bradley Erickson More articles by this author Jeremy Meyers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Bryan Voelzke More articles by this author Lee Zhao More articles by this author Alex Vanni More articles by this author Expand All Advertisement PDF downloadLoading ...

Successful management of pelvic urethral strictures with balloon dilation in 3 cats.

To describe the successful management of pelvic urethral strictures in 3 young cats (1 after perineal urethrostomy, 1 after a third-time urethral obstruction, and 1 with prolonged lower urinary tract signs post-urethral obstruction) using balloon dilation and a short-term, indwelling urethral catheter. A 9-month-old neutered male domestic longhair cat with a urethral obstruction and a suspected congenitally narrowed urethra was treated via perineal urethrostomy. The cat later developed acute kidney injury, multidrug-resistant urinary tract infections, and a pelvic urethral stricture. A second case, a 2.3-year-old neutered male domestic shorthair cat, developed a stricture of the pelvic urethra after multiple obstructions and catheterizations. A third case, a 1.2-year-old neutered male domestic shorthair cat, had persistent and prolonged lower urinary tract signs after treatment for a urinary obstruction. The cat also had an abnormally small urethral opening and was ultimately found to have a proximal urethral stricture. The strictures in all 3 cases were successfully treated with a combination of fluoroscopic-guided balloon dilation and short-term indwelling urethral catheterization while managing any present infection. To the authors' knowledge, this is the first published case series of successful balloon dilations paired with the use of a short-term indwelling urethral catheter in cats that developed urethral strictures after catheterization due to urinary obstructions. This procedure appears safe and well tolerated and appears to offer a long-term, cost-effective solution to urethral strictures at the level of the pelvis.

Analysis of prognostic factors of failure in perineal urethrostomy.

To identify prognostic factors of failure in patients undergoing perineal urethrostomy (PU) with Blandy technique, with inverted U-shaped perineal flap. This is a retrospective study of PU of non-oncological causes (2001-2017). Data of age, BMI, history of diabetes mellitus, etiology of urethral stricture, type of stricture, previous surgeries, dilatation and suprapubic catheter were collected. Failure was defined as the need for any instrumentation after surgery. Variables were analyzed by Cox regression and Kaplan-Meier curves were used for survival analysis. A total of 115 PU were performed. Median age was 61years (IQR 53-68) and BMI 27.9 (IQR 25-30.9). The most frequent etiologies were: lichen sclerosus (30.4%), iatrogenic (27%), and idiopathic (25.7%). 62.6% had panurethral stricture. There were no complications in 73%. Clavien I complications occurred in 25.2%, Clavien II in 0.9% and Clavien IVa in 0.9%. The overall success rate was 51.3% with a median follow-up of 71months. In the last 8years, it was 75%. In the multivariate analysis, we found that age (p = 0.01), BMI (p = 0.01), date of surgery (p = 0.01), and suprapubic catheter (p = 0.003) were predictive variables. The voiding satisfaction rate was 88.7%. PU with Blandy technique is a surgery with low morbidity. During the entire study period, it had a failure rate of 48.7% but the failure rate decreased to 25% over the last 8years. Age, BMI, date of surgery and suprapubic catheter are the most important prognostic factor of failure.

MANAGEMENT OF BULBAR URETHRAL ISCHEMIC NECROSIS FOLLOWING PELVIC FRACTURE URETHRAL INJURY REPAIR-A SINGLE CENTER EXPERIENCE

Aims &amp; Objectives:About 10% of pelvic fracture injuries are associated with urethral injury. Most of the urethral injuries are successfully repaired by progressive perineal anastomotic urethroplasty. Bulbar urethral ischemic necrosis is a devastating complication seen in 5-8% of failed PFUI repairs. The objective of this study is to present our experience in management of a bulbar urethral ischemic necrosis developed following PFUI repair. Materials &amp; methods:This is a retrospective study done at our institute, which includes data from feb,2003 to feb,2021. This is a descriptive statical analysis. Total 18 patients were managed using various surgical approaches and followed. Out of 18 patients seven patients underwent staged urethroplasty with Results &amp; Observations: success rate of 85.71%,four underwent pedicled preputial skin tube urethroplasty with success rate of 75%,one underwent non transecting augmented urethroplasty with success rate of 100%,three underwent augmented perineal urethrostomy, two underwent continent diversion procedures, one underwent augmented perineal skin tube perineal urethrostomy. Bulbar urethral ischemic necrosi Conclusions: s following PFUI repair although uncommon, is a devastating complication which can be salvaged by various surgical techniques. Type of procedure chosen depends on individual patient and outcomes vary for each type of procedure

Hipospadia em dois gatos - relato de caso

ABSTRACT Hypospadias is an uncommon sexual development disorder in cats, in which the urethral opening is not in its anatomical location on the penis. The purpose of this report is to describe two cases of hypospadias in the feline species. The first cat was asymptomatic, had a history of bacterial cystitis, and was diagnosed with perineal hypospadias at an appointment for preoperative evaluation of orchiectomy. The second cat had clinical signs of dysuria and pollakiuria for 30 days and had glandular hypospadias. Both cats showed abnormalities in the urinalysis which were suggestive of lower urinary tract disease. For both cases, clinical treatment with antibiotic therapy was performed. In the first patient, surgical treatment consisted of orchiectomy, while in the second animal a perineal urethrostomy and orchiectomy were performed. The cats had a satisfactory recovery after the treatments. Performing a thorough physical examination is essential to diagnose cases of hypospadias and choose the best treatment for each patient.

Rare presentation of penile cancer: a case report

Penile cancer is rare. Squamous cell cancer usually starts on glans or coronal sulcus as a nodule, foul smelly ulcer or cauliflower like mass, which invades corpora cavernosa as it progresses sparing the urethra until late in the course of the disease.We report a case of 32-year-old male with squamous cell carcinoma of penis in the form of ulcer involving shaft of penis at the base with surrounding inguinoscrotal region managed with en-mass wide local excision of the malignant ulcer taking 1 cm margin from all sides with total penectomy with partial left scrotal skin excision with left orchidectomy with perineal urethrostomy with local scrotal advancement flap reconstruction with bilateral superficial inguinal lymphnode biopsy. Post op period was satisfactory. At discharge, flap was healthy with well-functioning perineal urethrostomy. Patienthad received 6 cycles of adjuvant chemotherapy.Ca penis can be present in any rare form and hence early diagnosis and timely management is the key.

Extended long-term follow-up of salvage direct vision internal urethrotomy after failed buccal mucosal graft urethroplasty

Extended long-term follow-up of salvage direct vision internal urethrotomy after failed buccal mucosal graft urethroplasty