1
|
Palminteri E, Toso S, Preto M, Gatti L, Sedigh O, Buffi NM, Ferrari G, Gobbo A. Small intestinal submucosa graft bulbar urethroplasty is a viable technique: results compared to buccal mucosa graft urethroplasty after propensity score matching. World J Urol 2024; 42:123. [PMID: 38453722 DOI: 10.1007/s00345-024-04795-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Small intestinal submucosa (SIS) graft urethroplasty has been employed to decrease buccal mucosa morbidity and facilitate the procedure. The first published series had a short follow-up, inhomogeneous patient selection, and a lack of a control group. Our purpose is to report treatment outcomes at 13 years in a propensity score-matched cohort comparing bulbar urethroplasty with SIS (SISU) or buccal mucosa (BMU). METHODS From our institutional database of 1132 bulbar urethroplasties, we used propensity score matching with the nearest-neighbor method without replacement to generate a study sample of 25 BMU and 25 SISU. Failure was defined as any treatment after urethroplasty. Survival analyses were used to analyze treatment failure occurrence with data censored at 156mo. RESULTS Matching resulted in a complete correction of bias between the two samples except for the follow-up duration, which was slightly longer in the SIS group. The cumulative treatment success probability of BMU and SISU at 156mo was 83.4% and 68%, respectively. At multivariable Cox regression, SIS graft, previous urethrotomy, stricture length, and lower postoperative Qmax (within 2mo after catheter removal) were predictors of failure. Stricture length had a more remarkable effect in SISU, with estimated survival probabilities from the Cox model lower than 80% in strictures > = 3 cm. CONCLUSION SIS has poorer outcomes compared to BM but may still be useful when BM grafting is not possible. The best candidates for SISU, with similar success to BMU, are patients with strictures shorter than 3 cm, preferably without a history of DVIU.
Collapse
Affiliation(s)
- Enzo Palminteri
- Center for Urethral and Genitalia Reconstructive Surgery, Humanitas Cellini, Via Benvenuto Cellini 5, 10126, Turin, Italy
| | - Stefano Toso
- Department of Urology, University of Modena and Reggio Emilia, Via Università 4, 41121, Modena, Italy
| | - Mirko Preto
- Urology Clinic-A.O.U. "Città della Salute e della Scienza"-Molinette Hospital, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Lorenzo Gatti
- CURE Group, Department of Urology, Hesperia Hospital, Via Arguà 80, 41125, Modena, Italy
| | - Omid Sedigh
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo, Corso Regina Margherita 8, 10153, Turin, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giovanni Ferrari
- CURE Group, Department of Urology, Hesperia Hospital, Via Arguà 80, 41125, Modena, Italy
| | - Andrea Gobbo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| |
Collapse
|
2
|
Shalkamy O, Elsalhy M, Alghamdi SM, Beaiti M, Abdel-Al I, Faisal M, Abouelgreed TA, Badran Y, Abdrabu A, Al-Ayafi M, Bosily MJ, Shebl SE, Nematallah I, Shafiea A, Elatreisy A. Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference? BMC Urol 2023; 23:140. [PMID: 37620812 PMCID: PMC10463440 DOI: 10.1186/s12894-023-01281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE We aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome. MATERIALS AND METHODS We retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients' demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more. RESULTS The urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively. CONCLUSIONS Unfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.
Collapse
Affiliation(s)
- Osama Shalkamy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Mohamed Elsalhy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Mohammed Beaiti
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Ibrahim Abdel-Al
- Department of Urology, Faculty of Medicine, Assiut Branch, Al-Azhar University, Assiut, Egypt
| | - Mahmoud Faisal
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Tamer A Abouelgreed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Yasser Badran
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdrabu Abdrabu
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mahdi Al-Ayafi
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Mohanad Jebril Bosily
- Department of Urology, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | - Salah E Shebl
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Nematallah
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shafiea
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Adel Elatreisy
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
3
|
Blair Y. How Do We Assess Success After Surgical Management of Urethral Stricture Disease? CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
|
4
|
Yanagi T, Kanematsu A, Shimatani K, Yamamoto S. Uroflowmetry is a viable surrogate for urethroscopy in evaluation of anatomical success following urethroplasty. Int J Urol 2022; 30:390-394. [PMID: 36575864 DOI: 10.1111/iju.15137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study aimed to investigate the utility of uroflowmetry in predicting anatomical success following urethroplasty based on real-world clinical data. METHODS Data from 100 male patients who underwent urethroplasty for urethral strictures at our institute were analyzed. Postoperative anatomical success was determined as the passage of a 16.2 Fr flexible endoscope after approximately 4 months following the procedure. Sensitivity and specificity of the maximal flow rate (Qmax ), average flow rate (Qave ), and Qmax - Qave for anatomical success were determined, along with receiver operating characteristic analysis. The optimal cutoff was set using Youden's index. RESULTS Anatomical success was observed in 67%. Voided volumes in the success and failure groups were equivalent: 252 ± 121 versus 242 ± 91 ml, respectively. In 18 cases, voided volumes were <150 ml. Parameters of uroflowmetry were all significantly higher in the anatomical success group when compared to those in the failure group: the mean value of Qmax was 26.1 versus 15.0 ml/s; Qave , 14.2 versus 9.1 ml/s; and Qmax - Qave , 11.9 versus 5.9 ml/s, respectively (p < 0.0001 for each parameter). The area under the curve was 0.8082 for Qmax , 0.7727 for Qave , and 0.8186 for Qmax - Qave . Optimal cutoff values for Qmax and Qmax - Qave were 20 and 6 ml/s, which predicted anatomical success with 86% and 87% positive predictive value, respectively. CONCLUSION This analysis presents statistically valid cutoffs by which uroflowmetry can be used as a viable surrogate of anatomical success following urethroplasty in clinical practice.
Collapse
Affiliation(s)
- Toeki Yanagi
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Akihiro Kanematsu
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Kimihiro Shimatani
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| |
Collapse
|
5
|
Pang KH, Osman NI, Chapple CR, Eardley I. Erectile and Ejaculatory Function Following Anterior Urethroplasty: A Systematic Review and Meta-analysis. Eur Urol Focus 2022; 8:1736-1750. [PMID: 35430159 DOI: 10.1016/j.euf.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT The degree of change in erectile (EF) and ejaculatory function (EjF) according to validated questionnaires following anterior urethroplasty and different techniques is unclear. OBJECTIVE To investigate the evidence on EF and EjF evaluated via validated questionnaires following anterior urethroplasty. EVIDENCE ACQUISITION A systematic review (PROSPERO ID: CRD42021229797) of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The PubMed and CENTRAL databases were searched on February 1, 2021, with an updated search performed on December 1, 2021. Studies evaluating EF and/or EjF using validated questionnaires in men aged ≥18 yr following anterior urethroplasty were included. EVIDENCE SYNTHESIS Overall, 29 studies (two randomised and 27 nonrandomised) were included. The questionnaire most commonly used to evaluate EF and EjF was the International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ), respectively. The incidence of postoperative erectile dysfunction (ED) was 0-38% and the mean change in EF score according to the IIEF ranged from -4.0 to 2.5. The incidence of postoperative ejaculatory dysfunction (EjD) was 7.7-67% and the mean change in EjF score according to the MSHQ-EjD was 0.7-7.0. Meta-analyses revealed a mean difference of -0.87 (95% confidence interval [CI] -1.50 to -0.23; p = 0.008) in IIEF-EF score and 1.77 (95% CI 0.61-2.93; p = 0.003) in MSHQ-EjF score following anterior urethroplasty. CONCLUSIONS EF and EjF may be affected following anterior urethroplasty and men should be counselled appropriately. Owing to the variation in questionnaires and cutoff scores used, EF and EjF outcomes following different urethroplasty techniques are heterogeneous, with limited data from randomised controlled trials. An agreement on questionnaires and cutoff scores should be established to allow consistent reporting. Future research should aim to investigate best approaches for minimising sexual dysfunction. PATIENT SUMMARY Surgical repair of the urethra (urethroplasty) used to treat narrowing of the urethra (urethral stricture) may affect erectile and ejaculatory function. Different questionnaires and definitions are used to evaluate sexual function, so it is hard to compare data. The degree of disruption can be affected by different techniques and the severity of disease.
Collapse
Affiliation(s)
- Karl H Pang
- Institute of Andrology, University College Hospital, University College London Hospital NHS Foundation Trust, London, UK
| | - Nadir I Osman
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christopher R Chapple
- Section of Functional and Reconstructive Urology, Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ian Eardley
- Section of Andrology, Pyrah Department of Urology, St. James's Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK.
| |
Collapse
|
6
|
Gül M, Çulha MG, Bocu K, Batur AF, Altıntaş E, Kaynar M, Göktaş S, Kılıç Ö. Turkish Validation of the Hallym Post Micturition Dribble Questionnaire (HPMDQ) and Evaluation of Bulbar Urethral Massage Response. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
7
|
Ilie G, White J, Mason R, Rendon R, Bailly G, Lawen J, Bowes D, Patil N, Wilke D, MacDonald C, Rutledge R, Bell D. Current Mental Distress Among Men With a History of Radical Prostatectomy and Related Adverse Correlates. Am J Mens Health 2021; 14:1557988320957535. [PMID: 32938266 PMCID: PMC7503014 DOI: 10.1177/1557988320957535] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recent reviews and observational studies have reported that patients with prostate cancer (PCa) are at increased risk of mental health issues, which in turn negatively affects oncological outcomes. Here, we examine possible explanatory variables of mental distress in a population-based cohort of men who have undergone radical prostatectomy (RP). Data were derived from a Maritimes-Canada online survey assessing patient-reported quality of life outcomes between 2017 and 2019 administered to 136 men (47–88 years old, currently in a relationship) who have undergone RP for their PCa diagnosis. The primary outcome was a validated assessment of mental distress, the Kessler Psychological Distress Scale (K10). Urinary function was assessed using the International Prostate Symptom Score, and relationship satisfaction was assessed using the Dyadic Assessment Scale. A multivariate logistic regression assessed the contribution of urinary function, relationship satisfaction, age, multimorbidity, additional treatments, medication for depression and/or anxiety, and survivorship time. A total of 16.2% men in this sample screened positive for mental distress. The severity of urinary problems was positively associated with increased mental distress (OR = 4.79, 95% CI [1.04, 22.03]), while increased age (OR = 0.87, 95% CI [0.78, 0.97]), relationship satisfaction (OR = 0.14, 95% CI [0.3, .077]), and current medication for anxiety, depression, or both (OR = 0.09, 95% CI [0.02, 0.62]) were protective factors. Survivorship time, the presence of additional comorbidities, or PCa treatments were not identified to be statistically significant contributions to the fitted model. Here, we report that RP survivors are prone to presenting with increased mental distress long after treatment. Screening for mental distress during RP survivorship is recommended.
Collapse
Affiliation(s)
- Gabriela Ilie
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.,Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Joshua White
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ross Mason
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ricardo Rendon
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Greg Bailly
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Joseph Lawen
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - David Bowes
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Nikhilesh Patil
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Derek Wilke
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Cody MacDonald
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Robert Rutledge
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - David Bell
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
8
|
Campos-Juanatey F, Osman NI, Greenwell T, Martins FE, Riechardt S, Waterloos M, Barratt R, Chan G, Esperto F, Ploumidis A, Verla W, Dimitropoulos K, Lumen N. European Association of Urology Guidelines on Urethral Stricture Disease (Part 2): Diagnosis, Perioperative Management, and Follow-up in Males. Eur Urol 2021; 80:201-212. [PMID: 34103180 DOI: 10.1016/j.eururo.2021.05.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/20/2021] [Indexed: 02/01/2023]
Abstract
CONTEXT Urethral stricture management guidelines are an important tool for guiding evidence-based clinical practice. OBJECTIVE To present a summary of the 2021 European Association of Urology (EAU) guidelines on diagnosis, classification, perioperative management, and follow-up of male urethral stricture disease. EVIDENCE ACQUISITION The panel performed a literature review on the topics covering a time frame between 2008 and 2018, and using predefined inclusion and exclusion criteria for the literature. Key papers beyond this time period could be included if panel consensus was reached. A strength rating for each recommendation was added based on a review of the available literature after panel discussion. EVIDENCE SYNTHESIS Routine diagnostic evaluation encompasses history, patient-reported outcome measures, examination, uroflowmetry, postvoid residual measurement, endoscopy, and urethrography. Ancillary techniques that provide a three-dimensional assessment and may demonstrate associated abnormalities include sonourethrography and magnetic resonance urethrogram, although these are not utilised routinely. The classification of strictures should include stricture location and calibre. Urethral rest after urethral manipulations is advised prior to offering urethroplasty. An assessment for urinary extravasation after urethroplasty is beneficial before catheter removal. The optimal time of catheterisation after urethrotomy is <72 h, but is unclear following urethroplasty and depends on various factors. Patients undergoing urethroplasty should be followed up for at least 1 yr. Objective and subjective outcomes should be assessed after urethral surgeries, including patient satisfaction and sexual function. CONCLUSIONS Accurate diagnosis and categorisation is important in determining management. Adequate perioperative care and follow-up is essential for achieving successful outcomes. The EAU guidelines provide relevant evidence-based recommendations to optimise patient work-up and follow-up. PATIENT SUMMARY Urethral strictures have to be assessed adequately before planning treatment. Before surgery, urethral rest and infection prevention are advised. After urethral surgery, x-ray dye tests are advised before removing catheters to ensure that healing has occurred. Routine follow-up is required, including patient-reported outcomes. These guidelines aim to guide doctors in the diagnosis, care, and follow-up of patients with urethral stricture.
Collapse
Affiliation(s)
| | - Nadir I Osman
- Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Francisco E Martins
- Department of Urology, Santa Maria University Hospital, University of Lisbon, Lisbon, Portugal
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marjan Waterloos
- Division of Urology, Gent University Hospital, Gent, Belgium; Division of Urology, AZ Maria Middelares, Gent, Belgium
| | - Rachel Barratt
- Department of Urology, University College London Hospital, London, UK
| | - Garson Chan
- Division of Urology, University of Saskatchewan, Saskatoon, Canada
| | - Francesco Esperto
- Department of Urology, Campus Biomedico, University of Rome, Rome, Italy
| | | | - Wesley Verla
- Division of Urology, Gent University Hospital, Gent, Belgium
| | | | - Nicolaas Lumen
- Division of Urology, Gent University Hospital, Gent, Belgium
| |
Collapse
|
9
|
Calleja Hermosa P, Campos-Juanatey F, Varea Malo R, Correas Gómez MÁ, Gutiérrez Baños JL. Sexual function after anterior urethroplasty: a systematic review. Transl Androl Urol 2021; 10:2554-2573. [PMID: 34295743 PMCID: PMC8261436 DOI: 10.21037/tau-20-1307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/27/2021] [Indexed: 11/09/2022] Open
Abstract
Background Urethral surgery outcomes are often evaluated by assessing urinary flow and urethral patency. However, sexual consequences may appear after urethroplasty, impairing quality of life and patient’s perception of success. The aim of this study is to assess the relationship between anterior urethral reconstruction and postoperative sexual dysfunction, including the proposed factors predicting sexual outcomes. Methods We searched in PubMed database using the terms: “anterior urethroplasty”, bulbar urethroplasty” or “penile urethroplasty”, and “sexual dysfunction”, “erectile function” or “ejaculation”. Articles were independently evaluated for inclusion based on predetermined criteria. Systematic data extraction was followed by a comprehensive summary of evidence. Results Thirty-eight studies were included for final analysis. No randomised trial on the topic was found. Urethral surgery might affect different aspects of sexual function: erectile function, ejaculatory function, penile shape and length, and genital sensitivity, leading to severe sexual dysfunction. Patient perception of sexual impairment was related to post-operative satisfaction. Conclusions Sexual dysfunction after anterior urethral reconstruction is an important issue that must be appropriately discussed during preoperative patient counselling. Reported outcomes after anterior urethroplasty should include sexual consequences and relevance, evaluated using validated tools.
Collapse
Affiliation(s)
| | - Felix Campos-Juanatey
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Valdecilla Research Institute (IDIVAL), Santander, Spain
| | - Raquel Varea Malo
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Miguel Ángel Correas Gómez
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, Spain
| | - Jose Luis Gutiérrez Baños
- Urology Department, Marques de Valdecilla University Hospital, Santander, Spain.,Medical and Surgical Sciences Department, School of Medicine, University of Cantabria, Santander, Spain
| | | |
Collapse
|
10
|
Surgical and patient-reported outcomes of urethroplasty for bulbar stricture due to a straddle injury. World J Urol 2019; 38:1805-1811. [DOI: 10.1007/s00345-019-02971-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022] Open
|
11
|
Cedars BE, Cohen AJ, Fergus KB, Baradaran N, Ndoye M, Kamal P, Breyer BN. Qualitative Analysis of the Content Found in Online Discussion Boards for Urethral Stricture Disease and Urethroplasty. Urology 2019; 130:155-161. [DOI: 10.1016/j.urology.2019.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/22/2019] [Accepted: 03/29/2019] [Indexed: 12/11/2022]
|
12
|
Ercan M, Alp HH, Kocaturk H, Bakan N, Gul M. Oxidative stress before and after surgery in benign prostatic hyperplasia patients. Andrologia 2019; 51:e13326. [PMID: 31158928 DOI: 10.1111/and.13326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/07/2019] [Accepted: 05/01/2019] [Indexed: 01/15/2023] Open
Abstract
The aim was to assess oxidative stress in benign prostatic hyperplasia patients and also to evaluate the effect of operation in late (60 days) post-operative period. This study was conducted with 16 patients with benign prostatic hyperplasia and 16 healthy subjects. Serum malondialdehyde, blood 8-hydroxy-2'-deoxyguanosine/deoxyguanosine, erythrocyte superoxide dismutase, serum total coenzyme Q10 and coenzyme Q10 levels were measured. Independent samples t test was used to analyse the differences between control group and patients, while paired t test was used to analyse the differences between pre-operative and post-operative periods. Malondialdehyde and total coenzyme Q10 levels were lower in patients, while 8-hydroxy-2'-deoxyguanosine/deoxyguanosine level was increased. However, superoxide dismutase activity and coenzyme Q10 levels did not differ. After 60 days of operation, 8-hydroxy-2'-deoxyguanosine/deoxyguanosine and superoxide dismutase activity decreased, while total coenzyme Q10 level increased. However, malondialdehyde and coenzyme Q10 levels were not affected. The international prostate symptom scores of the patients were also decreased after the operation. The results suggest that blood 8-hydroxy-2'-deoxyguanosine/deoxyguanosine level may reflect the oxidative stress better than the malondialdehyde level, and surgical operation attenuates the oxidative stress in late post-operative period in benign prostatic hyperplasia patients.
Collapse
Affiliation(s)
- Mehlika Ercan
- Department of Physiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Hamit Hakan Alp
- Department of Biochemistry, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Huseyin Kocaturk
- Department of Urology, Regional Training and Research Hospital, Erzurum, Turkey
| | - Nuri Bakan
- Department of Biochemistry, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Mustafa Gul
- Department of Physiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| |
Collapse
|
13
|
Buckley JC. Moving Beyond an Age-Old Intervention. J Urol 2018; 199:353-354. [DOI: 10.1016/j.juro.2017.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jill C. Buckley
- Department of Urology, Reconstructive Urology and GU Trauma, UC San Diego Health, San Diego, California
| |
Collapse
|
14
|
Lucas ET, Koff WJ, Rosito TE, Berger M, Bortolini T, Neto BS. Assessment of satisfaction and Quality of Life using self -reported questionnaires after urethroplasty: a prospective analysis. Int Braz J Urol 2017; 43:304-310. [PMID: 28128915 PMCID: PMC5433370 DOI: 10.1590/s1677-5538.ibju.2016.0207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/15/2017] [Indexed: 01/08/2023] Open
Abstract
Objectives To assess patient satisfaction and quality of life after urethroplasty using two different self-reported outcome measures and to compare it with objective clinical data. Materials and Methods We prospectively collected data from 35 consecutive patients who underwent urethroplasty from January 2013 to September 2014. Patient demographics, International Prostate Symptom Score (IPSS), quality of life score, urethral stricture surgery patient-reported outcome measure (USS-PROM), maximum flow rate (Qmax) and post-void residual urine were collected before, two and eight months after surgery. Failure occurred when any postoperative instrumentation was performed. General estimation equation was used to compare the results and linear regression analysis to correlate both questionnaires with objective data. Results Mean age was 61 years. Urethroplasties were equally divided between anastomotic and buccal mucosa grafts and 19 patients (59.3%) had a previous urethral procedure. Overall success rate was 87.5%. IPSS improved from a mean 19 at baseline to 5.32 at 8 months (p <0.001). The mean USS-PROM score also improved from 13.21 preoperatively to 3.36 after surgery (p <0.001) and 84.3% of patients were satisfied or very satisfied with surgical results. Mean Qmax increased from 4.64mL/s to 11mL/s (p <0.001). Strong negative correlation was found respectively between flow rate and USS-PROM (r=-0.531, p <0.001) and with IPSS (r=-0.512, p <0.001). Conclusions Significant improvements in urinary symptoms and in quality of life are expected after urethroplasty and they are correlated with objective measures.
Collapse
Affiliation(s)
- Eduardo Terra Lucas
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Walter José Koff
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Tiago Elias Rosito
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Milton Berger
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Tiago Bortolini
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| | - Brasil Silva Neto
- Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
| |
Collapse
|
15
|
Önol FF, Bindayi A, Tahra A, Basibuyuk I, Onol SY. Turkish validation of the urethral stricture surgery specific patient-reported outcome measure (USS-PROM) with supplemental assessment of erectile function and morbidity due to oral graft harvesting. Neurourol Urodyn 2017; 36:2089-2095. [PMID: 28220592 DOI: 10.1002/nau.23243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/12/2017] [Accepted: 01/18/2017] [Indexed: 02/03/2023]
Abstract
AIMS We validated a Turkish language version of the urethral stricture surgery specific patient-reported outcome measure (USS-PROM) in men undergoing anterior urethroplasty. We also investigated changes in erectile function (EF) and quality of life (QoL) due to oral mucosa graft (OMG) harvesting. METHODS The USS-PROM captures lower urinary tract symptoms (LUTS), health related QoL (HRQoL) with EQ-5D visual analogue scale (EQ-VAS). To evaluate EF and OMG morbidity, we used International Index of Erectile Function (IIEF-5) and a self-completed questionnaire, respectively. Psychometric assessment of USS-PROM included test-retest reliability, internal consistency, criterion validity, and responsiveness. Objective evidence for urethroplasty success was demonstrated with fluoroscopic imaging and urethral calibration at post-operative six months. RESULTS Among the 101 men included during study period, 42 had complete pre- and postoperative 6th month data for analysis. The test-retest intraclass correlation was 0.79. Cronbach's α for internal consistency of the LUTS construct was 0.79. There was a significant negative correlation between total LUTS scores and peak flow rates, both preoperatively (r = -0.478) and postoperatively (r = -0.508). Mean baseline EQ-VAS increased from 70 to 84 postoperatively (P < 0.001), indicating improved HRQoL. IIEF scores did not change significantly after urethroplasty. Early and late-term QoL impairment rates due to OMG harvesting were 28.9 and 13.1%, respectively. Three (7.1%) men required endoscopic intervention for recurrence within 6 months. CONCLUSIONS Turkish version of USS-PROM showed comparable psychometric properties with the original version. Complementation of this instrument with additional measures that address sexual function and OMG morbidity provides better QoL assessment for urethral reconstruction.
Collapse
Affiliation(s)
| | - Ahmet Bindayi
- Department of Urology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Tahra
- Department of Urology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | | | | |
Collapse
|
16
|
Maciejewski CC, Haines T, Rourke KF. Chordee and Penile Shortening Rather Than Voiding Function Are Associated With Patient Dissatisfaction After Urethroplasty. Urology 2017; 103:234-239. [PMID: 28065809 DOI: 10.1016/j.urology.2016.12.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To identify factors that predict patient satisfaction after urethroplasty by prospectively examining patient-reported quality of life scores using 3 validated instruments. METHODS A 3-part prospective survey consisting of the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF) score, and a urethroplasty quality of life survey was completed by patients who underwent urethroplasty preoperatively and at 6 months postoperatively. The quality of life score included questions on genitourinary pain, urinary tract infection (UTI), postvoid dribbling, chordee, shortening, overall satisfaction, and overall health. Data were analyzed using descriptive statistics, paired t test, univariate and multivariate logistic regression analyses, and Wilcoxon signed-rank analysis. RESULTS Patients were enrolled in the study from February 2011 to December 2014, and a total of 94 patients who underwent a total of 102 urethroplasties completed the study. Patients reported statistically significant improvements in IPSS (P < .001). Ordinal linear regression analysis revealed no association between age, IPSS, or IIEF score and patient satisfaction. Wilcoxon signed-rank analysis revealed significant improvements in pain scores (P = .02), UTI (P < .001), perceived overall health (P = .01), and satisfaction (P < .001). Univariate logistic regression identified a length >4 cm and the absence of UTI, pain, shortening, and chordee as predictors of patient satisfaction. Multivariate analysis of quality of life domain scores identified absence of shortening and absence of chordee as independent predictors of patient satisfaction following urethroplasty (P < .01). CONCLUSION Patient voiding function and quality of life improve significantly following urethroplasty, but improvement in voiding function is not associated with patient satisfaction. Chordee status and perceived penile shortening impact patient satisfaction, and should be included in patient-reported outcome measures.
Collapse
Affiliation(s)
- Conrad C Maciejewski
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Haines
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
17
|
Haines T, Rourke KF. The effect of urethral transection on erectile function after anterior urethroplasty. World J Urol 2016; 35:839-845. [PMID: 27562579 DOI: 10.1007/s00345-016-1926-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/18/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To prospectively assess the effect of urethral transection on erectile function after anterior urethroplasty. METHODS From February 2012 to December 2014, 104 patients were enrolled in a prospective study assessing erectile function (EF) after anterior urethroplasty. Participants completed the International Index of Erectile Function (IIEF) questionnaire preoperatively and 6 months postoperatively. Outcome measures were the incidence of erectile dysfunction (ED) defined by ≥5-point change in EF and mean change in the EF domain. Factors examined were urethral transection, stricture location, patient age and other demographics. Fisher's exact test, Student's t test and linear regression were used to evaluate associations when appropriate. RESULTS Seventeen patients were excluded because of poor EF, leaving 87 patients for analysis. Twenty-two patients (25.3 %) had urethral transection during urethroplasty, while 65 underwent non-transecting techniques (74.7 %). For the entire cohort, IIEF scores remain unchanged (20.16 versus 20.14; p = 0.98). Eighteen patients (20.7 %) developed ED, while 15 (17.2 %) experienced an improvement in EF. Urethral transection was not associated with ED (p = 0.22) or mean change in EF (-0.8 versus +0.2; p = 0.71). Stricture location was not associated with ED, but patient age ≥50 was associated with a decrease in mean postoperative EF (-2.84 versus +1.85; p = 0.04). On linear regression analysis patient age remained independently associated with adverse change in EF (p = 0.05). CONCLUSIONS Urethroplasty can result in a decline in erectile function in some patients but overall is associated with minimal change in erectile function. Urethral transection is not associated with adverse change in erectile dysfunction after urethroplasty however, advanced patient age is.
Collapse
Affiliation(s)
- Trevor Haines
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| |
Collapse
|
18
|
The International Prostate Symptom Score (IPSS) Is an Inadequate Tool to Screen for Urethral Stricture Recurrence After Anterior Urethroplasty. Urology 2016; 95:197-201. [PMID: 27109599 DOI: 10.1016/j.urology.2016.04.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To validate the use of the International Prostate Symptom Score (IPSS) as a stand-alone tool to detect urethral stricture recurrence following urethroplasty. MATERIALS AND METHODS This study included 393 men who had undergone anterior urethroplasty and were enrolled in a multi-institutional outcomes study. Data analyzed included pre- and post-operative answers to the IPSS in addition to findings from a same- day cystoscopy. IPSS from men found to have cystoscopic recurrence were then compared to scores from those with successful repairs, and receiver operating characteristic curves were plotted to illustrate the predictive ability of these questions to screen for cystoscopic recurrence. RESULTS Mean postoperative scores were lower (fewer symptoms) in successful repairs; IPSS improved from preoperative values regardless of recurrence. Successful repairs had significantly better degree of improvement in question #5 (assessing weak stream) compared to recurrences. Receiver operating characteristic curves demonstrated the highest area under the curve for the IPSS quality of life question (0.66) that alone outperformed the complete IPSS questionnaire (0.56). CONCLUSION The IPSS had inadequate sensitivity and specificity to be used as a stand-alone screening tool for stricture recurrence in this large cohort of men, highlighting the need to continue development of a disease-specific, validated patient-reported outcome measure.
Collapse
|
19
|
Bertrand LA, Voelzke BB, Elliott SP, Myers JB, Breyer BN, Vanni AJ, McClung CD, Tam CA, Warren GJ, Erickson BA. Measuring and Predicting Patient Dissatisfaction after Anterior Urethroplasty Using Patient Reported Outcomes Measures. J Urol 2016; 196:453-61. [PMID: 26907509 DOI: 10.1016/j.juro.2016.01.117] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success. MATERIALS AND METHODS Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction. RESULTS At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurrence were more likely to report dissatisfaction (OR 4.96, 95% CI 2.07-11.90) and men reporting dissatisfaction had significantly worse uroflowmetry measures (each p <0.02). When controlling for recurrence, multivariate analysis revealed that urethra and bladder pain (OR 1.71, 95% CI 1.05-2.77 and OR 2.74, 95% CI 1.12-6.69, respectively), a postoperative decrease in sexual activity (OR 4.36, 95% CI 2.07-11.90) and persistent lower urinary tract symptoms (eg straining to urinate OR 3.23, 1.74-6.01) were independent predictors of dissatisfaction. CONCLUSIONS Overall satisfaction after anterior urethroplasty is high and traditional measures of surgical success strongly correlate with satisfaction. However, independently of the anatomical appearance of the reconstructed urethra, postoperative pain, sexual dysfunction and persistent lower urinary tract symptoms were predictors of patient dissatisfaction.
Collapse
Affiliation(s)
- Laura A Bertrand
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bryan B Voelzke
- Department of Urology, University of Washington, Seattle, Washington
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Jeremy B Myers
- Department of Urology, University of Utah, Salt Lake City, Utah
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | | | - Christopher A Tam
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gareth J Warren
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bradley A Erickson
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | | |
Collapse
|
20
|
Patel DP, Elliott SP, Voelzke BB, Erickson BA, McClung CD, Presson AP, Zhang C, Myers JB. Patient-Reported Sexual Function After Staged Penile Urethroplasty. Urology 2015. [PMID: 26199158 DOI: 10.1016/j.urology.2015.04.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). METHODS We identified men with completed staged penile urethroplasty with OMG from the Trauma and Urologic Reconstruction Network of Surgeons database between January 1, 2010 and May 1, 2014. Our primary outcome was change in total Sexual Health Inventory for Men (SHIM) and total Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) Short Form at baseline vs after the second stage of the procedure. Second, we assessed subjective changes in penile curvature, length, and sensation. RESULTS Thirty-three patients were included with a mean age of 45 years and mean body mass index of 27.6 kg/m(2). Urethral strictures arose from failed hypospadias repair in 52% and lichen sclerosus in 27%. Fifty-two percent of patients reported a previous urethroplasty. The median follow-up time between the second stage procedure and postoperative questionnaires was 6.3 months (interquartile range: 3.5-13.3). There was no significant change in the total SHIM (Δ0.64, 95% confidence interval [CI]: -3.00∼1.72) and MSHQ-EjD (Δ1.55, 95% CI: -1.53∼4.63) scores preoperatively vs postoperatively. In addition, 32% reported improved and 52% no change in satisfaction with sexual intercourse (SHIM Q5). Forty percent of patients reported reduced and 45% no change in bother with ejaculation after surgery (MSHQ-EjD Q4). Men reported new penile curvature (23%), loss of penile length (55%), and altered penile sensitivity (45%) after surgery. CONCLUSION Patients undergoing staged penile urethroplasty with OMG are likely to have minimal changes in erectile and ejaculatory function postoperatively, although many may experience new penile curvature, reduced penile length, and/or reduced penile sensitivity.
Collapse
Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, The Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT.
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN
| | - Bryan B Voelzke
- Department of Urology, University of Washington, Seattle, WA
| | - Bradley A Erickson
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, The Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, UT
| | | |
Collapse
|
21
|
Psychometric validation of a German language version of a PROM for urethral stricture surgery and preliminary testing of supplementary ED and UI constructs. World J Urol 2015; 34:369-75. [PMID: 26049865 DOI: 10.1007/s00345-015-1610-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/31/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To validate a German language version of the patient-reported outcome measurement (PROM) following urethral stricture surgery (USS) in a cohort of men undergoing one-stage buccal mucosa graft urethroplasty (BMGU) for urethral stricture. Furthermore, to explore the responsiveness of erectile function (EF) and urinary incontinence (UI) constructs in the context of this intervention. METHODS The USS-PROM captures voiding symptoms (ICIQ-MLUTS) and health-related quality of life (HRQoL) (EQ-5D). To evaluate EF and UI, the IIEF-5 and ICIQ-UI SF were included. Between March 2012 and April 2013, all patients undergoing BMGU at our institution were prospectively enrolled in this study. Psychometric assessment included internal consistency, test-retest reliability, criterion validity and responsiveness. RESULTS Ninety-three men completed the USS-PROM before and 3 months after surgery, with 40 (43 %) also completing the USS-PROM 6 months after surgery to assess reliability. Internal consistency: for the ICIQ-MLUTS, Cronbach's α was 0.83. The test-retest intraclass correlation coefficient was 0.94. There was a negative correlation between change in ICIQ-MLUTS total score and change in Q max (r = -0.40). All values exceeded our predefined thresholds. Significant improvements of voiding symptoms and HRQoL demonstrate responsiveness to change (all p values <0.001). While ICIQ-UI scores did not change (p > 0.05), IIEF-5 scores improved significantly (p = 0.048). CONCLUSIONS The German language USS-PROM shows similar psychometric properties to the English language version. This instrument can be improved by assessing EF by the use of IIEF-5. Further studies with larger patient cohorts are needed to evaluate the significance of measuring UI in urethroplasty patients.
Collapse
|
22
|
Ahyai SA, Schmid M, Kuhl M, Kluth LA, Soave A, Riechardt S, Chun FKH, Engel O, Fisch M, Dahlem R. Outcomes of Ventral Onlay Buccal Mucosa Graft Urethroplasty in Patients after Radiotherapy. J Urol 2015; 194:441-6. [PMID: 25846417 DOI: 10.1016/j.juro.2015.03.116] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated stricture-free survival and functional outcomes of buccal mucosa graft urethroplasty in patients with urethral stricture disease after radiotherapy. MATERIALS AND METHODS We reviewed our urethroplasty database for patients with a radiotherapy history who underwent buccal mucosa graft urethroplasty between January 2009 and October 2013. We reviewed patient charts and the institutional, standardized, nonvalidated questionnaires administered to each patient postoperatively. Study end points included 1) the success rate, 2) continence status, 3) erectile function and 4) patient satisfaction postoperatively. Success was defined as stricture-free survival. RESULTS Of 38 men included in the study prostate cancer was the most common indication for radiotherapy in 35 (92.1%). External beam radiotherapy was performed in 24 cases (64.9%), brachytherapy was done in 8 (21.6%) and a combination of the 2 treatments was performed in 6 (13.5%). Strictures were in the bulbar/bulbomembranous urethra and had a median length of 3.0 cm (range 1.0 to 8.0). The overall success rate was 71.1% at a median followup of 26.5 months (range 1.0 to 50.0). Median time to stricture recurrence was 17.0 months (range 3.0 to 44.0). De novo urinary incontinence was observed in 4 patients (10.5%). Erectile function remained mostly unchanged compared to preoperative status. Study limitations include the small sample size and the lack of validated questionnaires. CONCLUSIONS At short-term to mid-term followup the success rate of ventral onlay buccal mucosa graft urethroplasty in patients with radiotherapy history seems acceptable. However, patients must be counseled about the increased risk of urinary incontinence. Longer followup is warranted to address long-term outcomes.
Collapse
Affiliation(s)
- Sascha A Ahyai
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Marianne Schmid
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marie Kuhl
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luis A Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K-H Chun
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
23
|
International multi-institutional experience with the vessel-sparing technique to reconstruct the proximal bulbar urethra: mid-term results. World J Urol 2015; 33:2153-7. [PMID: 25690318 DOI: 10.1007/s00345-015-1512-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/09/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To present mid-term outcomes from an international, multi-institutional cohort of patients undergoing vessel-sparing excision and primary anastomosis urethroplasty for the reconstruction of the anterior urethra. MATERIALS AND METHODS From June 2003 to December 2011, 68 patients underwent vessel-sparing anterior urethral reconstruction at five different international institutions using the vessel-sparing technique described by Jordan et al. (J Urol 177(5):1799-1802, 2007). RESULTS Patients' age range was from 3 to 82 years (mean 51.2). Stricture length ranged from 1 to 3 cm (mean 1.78). After a mean follow-up of 17.6 months, 95.6 % of patients had a widely patent urethral lumen. Three patients failed the procedure, requiring either direct vision internal urethrotomy or urethral dilation, after which all were free of symptoms and did not require further instrumentation. Complications were minimal and as expected following open urethroplasty. CONCLUSION Preservation of blood supply is a noble pursuit in surgery; however, it can be technically difficult and often requires more time and effort. This vessel-sparing technique for anterior urethral reconstruction is reproducible and appears to be reliable in this international cohort. Larger studies and longer follow-up are needed to support these encouraging results.
Collapse
|
24
|
Bertrand LA, Warren GJ, Voelzke BB, Elliott SP, Myers JB, McClung CD, Oleson JJ, Erickson BA. Lower urinary tract pain and anterior urethral stricture disease: prevalence and effects of urethral reconstruction. J Urol 2014; 193:184-9. [PMID: 25046621 DOI: 10.1016/j.juro.2014.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE Anterior urethral stricture disease most commonly presents as urinary obstruction. Lower urinary tract pain is not commonly reported as a presenting symptom. We prospectively characterized lower urinary tract pain in association with urethral stricture disease and assessed the effects of urethroplasty on this pain. MATERIALS AND METHODS Men (18 years old or older) with anterior urethral stricture disease were prospectively enrolled in a longitudinal, multi-institutional, urethral reconstruction outcomes study from June 2010 to January 2013 as part of TURNS (Trauma and Urologic Reconstruction Network of Surgeons). Preoperative and postoperative lower urinary tract pain was assessed by the validated CLSS. Voiding and sexual function was assessed using validated patient-reported measures, including I-PSS. RESULTS Preoperatively 118 of 167 men (71%) reported urethral pain and 68 (41%) reported bladder pain. Age was the only predictor of urethral pain with men 40 years or younger reporting more pain than those 60 years old or older (81% vs 58%, p = 0.0104). Lower urinary tract pain was associated with worse quality of life and overall voiding symptoms on CLSS and I-PSS (each p <0.01). Postoperatively lower urinary tract pain completely resolved in 64% of men with urethral pain and in 73.5% with bladder pain. There were no predictive factors for changes in lower urinary tract pain after urethral reconstruction. CONCLUSIONS Lower urinary tract pain is common in urethral stricture disease, especially in younger men. It is associated with worse quality of life and voiding function. In most men lower urinary tract pain resolves after urethral reconstruction.
Collapse
Affiliation(s)
- Laura A Bertrand
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gareth J Warren
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bryan B Voelzke
- Department of Urology, Harborview Medical Center, University of Washington Medical Center, Seattle, Washington
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, Utah
| | | | - Jacob J Oleson
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Bradley A Erickson
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | | |
Collapse
|
25
|
Jackson MJ, Chaudhury I, Mangera A, Brett A, Watkin N, Chapple CR, Andrich DE, Pickard RS, Mundy AR. A prospective patient-centred evaluation of urethroplasty for anterior urethral stricture using a validated patient-reported outcome measure. Eur Urol 2013; 64:777-82. [PMID: 23664422 DOI: 10.1016/j.eururo.2013.04.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 04/19/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies of interventions for urethral stricture have inferred patient benefit from clinician-driven outcomes or questionnaires lacking scientifically robust evidence of their measurement properties for men with this disease. OBJECTIVE To evaluate urethral reconstruction from the patients' perspective using a validated patient-reported outcome measure (PROM). DESIGN, SETTING, AND PARTICIPANTS Forty-six men with anterior urethral stricture at four UK urology centres completed the PROM before (baseline) and 2 yr after urethroplasty. INTERVENTION A psychometrically robust PROM for men with urethral stricture disease. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Lower urinary tract symptoms (LUTS), health status, and treatment satisfaction were measured, and paired t and Wilcoxon matched-pairs tests were used for comparative analysis. RESULTS AND LIMITATIONS Thirty-eight men underwent urethroplasty for bulbar stricture and eight for penile stricture. The median (range) follow-up was 25 (20-30) mo. Total LUTS scores (0 = least symptomatic, 24 = most symptomatic) improved from a median of 12 at baseline to 4 at 2 yr (mean [95% confidence interval (CI)] of differences 6.6 [4.2-9.1], p < 0.0001). A total of 33 men (72%) felt their urinary symptoms interfered less with their overall quality of life, 8 (17%) reported no change, and 5 (11%) were worse 2 yr after urethroplasty. Overall, 40 men (87%) remained "satisfied" or "very satisfied" with the outcome of their operation. Health status visual analogue scale scores (100 = best imaginable health, 0 = worst) 2 yr after urethroplasty improved from a mean of 69 at baseline to 79 (mean [95% CI] of differences 10 [2-18], p = 0.018). Health state index scores (1 = full health, 0 = dead) improved from 0.79 at baseline to 0.89 at 2 yr (mean [95% CI] of differences 0.10 [0.02-0.18), p = 0.012]). CONCLUSIONS This is the first study to prospectively evaluate urethral reconstruction using a validated PROM. Men reported continued relief from symptoms with related improvements in overall health status 2 yr after urethroplasty. These data can be used as a provisional reference point against which urethral surgeons can benchmark their performance.
Collapse
|