[Urethral stricture : From diagnostics to appropriate treatment]

Management and outcomes of urethral stricture: single centre experience over 13 years

AIM

To present a comprehensive summary of the diagnosis, treatment and follow-up process of patients who underwent open urethroplasty in our tertiary referral center for the treatment of urethral stricture in the last 13 years.

MATERIALS AND METHODS

Two hundred and forty-five (245) patients who underwent open urethroplasty between January 2008 and June 2021 were retrospectively analysed. Detailed history, physical examination, uroflowmetry, retrograde urethrography and/or voiding cystourethrography and/or urethroscopy were used throughout the preoperative diagnosis process. While evaluating the postoperative patency rates, the absence of preoperative voiding symptoms after the operation and Qmax 15 ml/sec and above were taken into account.

RESULTS

Mean stricture length was 3.8 +/- 1.4 cm. Transurethral endoscopic interventions in 79 patients (32.2%), catheterisation in 55 patients (22.4%), trauma in 54 patients (22%), infection in 15 patients (6.2%), and idiopathology in 42 patients (17.2%) were the causes for the stricture. Buccal mucosal graft was used in 125 patients (51%), penile skin flap in 32 patients (13%), end-to-end anastomosis in 83 patients (33.8%) and Heineke-Mikulicz technique in 5 patients (2%). Mean follow-up period was 67.1 +/- 28.9 months. Success rates of patients were 84% (105) in buccal mucosal graft, 78.1% (25) in penile skin flap, 86.7% (72) with end-to-end anastomosis and 80% (4) with Heineke-Mikulicz technique.

CONCLUSION

Among treatment options for urethral stricture, urethroplasty techniques is the most successful treatment. Consideration of the factors leading to the formation of the stricture, with the intraoperative findings and surgical experience will maximize the benefit the patient receives.

Circ_0047339 promotes the activation of fibroblasts and affects the development of urethral stricture by targeting the miR-4691-5p/TSP-1 axis

Urethral stricture is related to scar tissue fibrosis, but its pathogenesis is still unclear. This study aims to explore the regulatory mechanism of circular RNA (circRNA) in the occurrence and development of urethral stricture. CircRNA microarray was employed to analyze circRNA expression profiles between human urethral scar tissue and normal urethral tissue. The results of circRNA microarray showed that there were 296 differentially expressed genes between urethral scar tissue and normal urethral tissue. The enrichment analysis of Kyoto encyclopedia of genes and genomes showed that these circRNAs were significantly correlated with ECM–receptor interaction. The first nine differentially expressed circRNA were selected to predict the circRNA–miRNA network. RT-qPCR results showed that circ_0047339 was upregulated considerably in urethral scar tissue. Urethral scar fibroblasts were isolated from human urethral scar tissue and cultured in vitro. After silencing circ_0047339, the proliferation of urethral scar cells decreased significantly, and the expressions of Collagen I (COL-1) and α-smooth muscle actin (α-SMA) also reduced. As a competing endogenous RNA, circ_0047339 could increase the expression of TSP-1 by competitively binding miR-4691-5p. In addition, miR-4691-5p mimic transfection could inhibit the proliferation of urethral scar fibroblasts and the presentation of thrombospondin-1 (TSP-1), α-SMA and COL-1, while circ_0047339 overexpression eliminated this inhibition. Our results showed that circ_0047339 might promote the growth and fibrosis of urethral scar fibroblasts through miR-4691-5p/TSP-1 axis, thus promoting the development of urethral stricture.

[Bulbar urethral strictures : A trivial urological disease or a surgical challenge?]

Urethral strictures are often located in the bulbar urethra, and bulbar strictures are commonly due to urethral trauma. Diagnosis is confirmed by radiographic imaging of the urethra. In cases of short primary bulbar strictures, a simple internal urethrotomy may be curative. In contrast, open surgery should be performed in long segment or recurrent strictures because recurrence rates are near 100% in these cases. Depending of the actual findings and comorbidities, end-to-end anastomosis, graft urethroplasty, flap urethroplasty, or perineal urethrostomy may be used. If definitive treatment using open surgery is delayed and multiple endoscopic treatments are tried, urethroplasty becomes more complex and success rates of definitive treatment decline.

A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease

To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Therefore, this article is dedicated to encompassing the currently existing data upon anatomy, etiology, symptoms, diagnosis, and treatment of the disease, based on more than 40 years of experience at a tertiary referral center and a PubMed literature review enclosing publications until September 2018.

[Diagnostic workup of urethral strictures]

Urethral stricture is a narrowing of the urethra due to scar tissue. It causes obstructive voiding dysfunction and can lead to long-term damage of the entire urinary tract. The probability of therapeutic success is dampened by a high rate of recurrence. Therefore, a careful taking of the patient's history and further diagnostics are crucial for finding the appropriate form of therapy. This review highlights the clinical presentation and diagnostic workup of urethral strictures.