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Mostafa D, Higazy A, Raslan ML, Salim MS. Intralesional injection of mitomycin C following visual internal urethrotomy for recurrent urethral stricture: a randomized controlled study. Urologia 2025; 92:288-293. [PMID: 39387252 DOI: 10.1177/03915603241283109] [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] [Indexed: 10/15/2024]
Abstract
AIM To assess the efficacy of Intralesional injection of mitomycin C (MMC) following visual internal urethrotomy (VIU) in the management of recurrent urethral stricture. MATERIALS Fifty male patients diagnosed with recurrent single bulbar urethral stricture measuring less than 1.5 cm previously treated with VIU were randomly allocated into two equal groups, (Group A) planned for VIU only and (Group B) planned for VIU with intralesional MMC injection using Botox injection needle. All patients were objectively evaluated pre- and post-operatively at 3, 6, and 12 months using uroflowmetry, post-void residual urine volume, and retrograde urethrography. RESULTS Forty-five patients completed their follow-up in our study. Patients who underwent intralesional MMC injection showed significant improvement in uroflowmetry, post-voiding residual, and with a success rate (82.6% in Group B, compared to 50% in Group A with a highly statistically significant difference, p-value: <0.001). VIU with MMC was the only factor associated with a marked decrease in stricture recurrence (p = 0.02) as shown in the Multivariate Cox regression analysis. CONCLUSION Intralesional injection of mitomycin C seems to be a safe and effective modality in reducing the recurrent stricture rate after VIU.
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Affiliation(s)
| | - Ahmed Higazy
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Singh K, Gaur AS, Mandal S, Tarigopula V, Das MK, Tripathy S, Sabique C, Barik K, Nayak P. Comparative efficacy of autologous adult live cultured buccal epithelial cells (AALBEC) and minced buccal mucosal graft endourethral urethroplasty (MBGEU) in male urethral stricture. Int Urol Nephrol 2025:10.1007/s11255-025-04526-x. [PMID: 40299181 DOI: 10.1007/s11255-025-04526-x] [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: 02/11/2025] [Accepted: 04/14/2025] [Indexed: 04/30/2025]
Abstract
PURPOSE To conduct a comparative analysis of autologous adult live cultured buccal epithelial cells (AALBEC) and minced buccal mucosal graft endourethral urethroplasty (MBGEU) in treatment of bulbar urethral stricture disease (USD) by evaluating and comparing their efficacy, safety, and patient outcomes. METHODS This study was conducted in a tertiary-care center and included 90 males with primary, < 4 cm bulbar USD. In AALBEC arm (30 patients), AALBEC was implanted after DVIU. While in the MBGEU arm (60 patients), a 1 × 1 cm buccal mucosal graft was harvested, minced, centrifuged, and suspended in fibrin glue, and after DVIU, the suspension was instilled via a 5-Fr ureteric catheter over the urethrotomy site. The primary objective was to compare success rates. The secondary objectives were to compare changes in the American Urological Association (AUA) symptom score, peak flow rate (Qmax), and post-void residue (PVRU) post-operatively and also to look for any adverse events related to surgery. RESULTS The success rate of AALBEC was 73.33% and of MBGEU was 90% at 6 months (p 0.041). The stricture recurred in eight and six patients, respectively. Although both groups showed a significant increase in Qmax compared to preoperative values, MBGEU group demonstrated significantly greater improvement in Qmax at 3 months (p 0.002) and 6 months (p < 0.0001) compared to the AALBEC group. No significant donor site morbidity was seen. In AALBEC group, two patients had sepsis in postoperative period. CONCLUSION The medium-term success of MBGEU is encouraging over AALBEC. However, a longer follow-up and further studies with a larger sample size are required.
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Affiliation(s)
- Kirti Singh
- Urology Department, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | | | - Swarnendu Mandal
- Urology Department, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India.
| | - Vivek Tarigopula
- Urology Department, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Manoj Kumar Das
- Urology Department, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Sambit Tripathy
- Urology Department, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - C Sabique
- Urology Department, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Kalandi Barik
- Urology Department, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
| | - Prasant Nayak
- Urology Department, AIIMS Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India
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Herout R, Flegar L, Putz J, Eisenmenger N, Huber J, Thomas C, Baunacke M. Increasing utilization of urethroplasty for male urethral stricture disease: analysis of in-hospital interventions in Germany from 2006 to 2023. Int Urol Nephrol 2025:10.1007/s11255-025-04487-1. [PMID: 40295328 DOI: 10.1007/s11255-025-04487-1] [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: 02/02/2025] [Accepted: 03/25/2025] [Indexed: 04/30/2025]
Abstract
PURPOSE There is a wide range of surgical treatments for urethral strictures. There is no information on the extent to which these procedures have been used over the past few years. METHODS We analyzed data from Diagnosis Related Groups (DRG) billing data from DESTATIS. Linear regression models were utilized for the analysis of trends over time. RESULTS A significant decrease of male urethral stricture cases during the study period was observed. Cases decreased from 48,020 cases in 2006 to 33,062 cases in 2023, i.e. -31%. This decline was mainly driven by the decrease in cases in the younger age group (≤ 79 years), whereas a significant increase was noted in octogenarians (+ 24%). A total of 834,476 procedures for urethral stricture disease were analyzed. In accordance with total case numbers, inpatient surgical interventions for urethral stricture disease decreased by 39% during the study period. Internal urethrotomy significantly decreased by 50% (from 41,443 in 2006 to 20,777 in 2023; p < 0.001). Likewise, urethral dilatations significantly decreased by 17% (from 14,134 in 2006 to 11,674 in 2023; p = 0.002). On the contrary, urethroplasties significantly increased by 156% (from 873 in 2006 to 2,239 in 2023; p < 0.001). CONCLUSION We present contemporary data on urethral stricture disease management in Germany. Case numbers of internal urethrotomies and urethral dilatations are declining while urethroplasty is increasingly utilized as a definitive treatment for urethral stricture disease. This may reflect an optimized treatment of urethral strictures with more urethroplasties and thus fewer relapses to be treated.
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Affiliation(s)
- Roman Herout
- Department of Urology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Marburg, Germany
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - Juliane Putz
- Department of Urology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | | | - Johannes Huber
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Thomas
- Department of Urology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
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Endo D, Robayo J, García-Perdomo HA. Predictors of urethral stricture recurrence following internal urethrotomy: A systematic review. Urologia 2025; 92:32-38. [PMID: 39460554 DOI: 10.1177/03915603241292191] [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] [Indexed: 10/28/2024]
Abstract
OBJECTIVE To estimate the factors associated with urethral stricture recurrence in patients undergoing internal urethrotomy by direct vision. METHODS A systematic review was performed in MEDLINE (Ovid), EMBASE, LILACS, and central databases. Clinical, quasi-experimental, cohort, case-control, and cross-sectional trials were included. RESULTS The search strategy found 402 studies, and 6 were finally included. All of them were clinical trials. A total of 1723 patients diagnosed with urethral stricture undergoing internal urethrotomy were included. The primary associated factor was the association between the length of stricture and recurrence. Other factors described were post-RTU as etiology, previous interventions for urethral stricture management, and previous Qmax on uroflowmetry less than 5 ml/s. CONCLUSION The length of urethral stricture was identified as the leading association with stricture recurrence following internal urethrotomy. Other associated factors were post-URT as etiology, previous interventions for managing stricture, and Qmax less than 5 ml/s. However, studies with better methodology are required.
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Affiliation(s)
- David Endo
- Division of Urology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Jaime Robayo
- Division of Urology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Herney Andrés García-Perdomo
- Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
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Horiguchi A, Shinchi M, Hirano Y, Asanuma H, Ishiura Y, Inoue K, Kanematsu A, Tabei T, Tamura Y, Nakajima Y, Moriya K, Yagihashi Y, Fukagai T, Fujii Y. Clinical questions in the Japanese Urological Association's 2024 clinical practice guidelines for urethral strictures. Int J Urol 2024; 31:956-967. [PMID: 38874432 DOI: 10.1111/iju.15512] [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: 04/18/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
Transurethral procedures such as direct vision internal urethrotomy and urethral dilation have been the traditional treatments for urethral strictures. However, transurethral procedures are associated with high recurrence rates, resulting in many uncured cases and prompting major international urological societies to recommend urethroplasty as the standard treatment owing to its high success rate. In contrast, many Japanese general urologists have little doubts about treating urethral strictures with transurethral treatment. Therefore, urethral stricture treatments in Japan are not in line with those used in other countries. To address this, the Trauma, Emergency Medicine, and Reconstruction Subcommittee of the Japanese Urological Association has developed guidelines to offer standardized treatment protocols for urethral stricture, based on international evidence and tailored to Japan's medical landscape. These guidelines target patients with a clinically suspected urethral stricture and are intended for urologists and general practitioners involved in its diagnosis and treatment. Following the Minds Clinical Practice Guideline Development Manual 2020, the committee identified eight critical clinical issues and formulated eight clinical questions using the "patient, intervention, comparison, and outcome" format. A comprehensive literature search was conducted. For six clinical questions addressed by the existing guidelines or systematic reviews, the level of evidence was determined by qualitative systematic reviews. Quantitative systematic reviews and meta-analyses were performed for the two unique clinical questions. The recommendation grades were determined using the Delphi method and consensus by the committee. These guidelines will be useful to clinicians in daily practice, especially those involved in the care of urethral strictures.
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Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
- Division of Trauma Reconstruction, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yusuke Hirano
- Department of Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | | | - Koji Inoue
- Department of Urology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akihiro Kanematsu
- Department of Urology, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tadashi Tabei
- Department of Urology, Fujisawa Shonandai Hospital, Fujisawa, Kanagawa, Japan
| | - Yoshimi Tamura
- Department of Urology, Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | | | - Kimihiko Moriya
- Department of Pediatric Urology, Jichi Children's Medical Center Tochigi, Shimotsuke, Tochigi, Japan
| | - Yusuke Yagihashi
- Department of Urology, Shizuoka City Shizuoka Hospital, Shizuoka City, Shizuoka, Japan
| | - Takashi Fukagai
- Department of Urology, Showa University, Shinagawa, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
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Sedigh O, Dalmasso E, Gobbo A, Dashti MH, Bagheri F, Shamsodini A, Alqattan Y, Soleimanzadeh F, Buffi NM, Gontero P, Hosseini J. Feasibility and Outcomes of Temporary Bulbar Urethral Stent Placement After Internal Urethrotomy in the Largest Multicenter Series. Eur Urol 2023; 84:313-320. [PMID: 37270392 DOI: 10.1016/j.eururo.2023.05.019] [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: 02/27/2023] [Revised: 04/21/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Recent 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. OBJECTIVE To report complications and outcomes from the largest series of patients receiving a temporary bulbar urethral stent to date. DESIGN, SETTING, AND PARTICIPANTS We 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 PROCEDURE DVIU 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. MEASUREMENTS All 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 LIMITATIONS A 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). CONCLUSIONS Temporary 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 SUMMARY We 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.
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Affiliation(s)
- Omid Sedigh
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo, Turin, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ettore Dalmasso
- Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Andrea Gobbo
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo, Turin, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | | | - Fariborz Bagheri
- Department of Urology, Dubai Health Authority, Dubai, United Arab Emirates
| | - Ahmad Shamsodini
- Urology Section, Department of Surgery, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Yaqoub Alqattan
- Department of Urology and Reconstructive Andrology, Humanitas Gradenigo, Turin, Italy
| | | | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Paolo Gontero
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Jalil Hosseini
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kuniakova M, Klein M, Galfiova P, Csobonyeiova M, Feitscherova C, Polak S, Novakova ZV, Topoliova K, Trebaticky B, Varga I, Danisovic L, Ziaran S. Decellularization of the human urethra for tissue engineering applications. Exp Biol Med (Maywood) 2023; 248:1034-1042. [PMID: 37073134 PMCID: PMC10581165 DOI: 10.1177/15353702231162092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/24/2023] [Indexed: 04/20/2023] Open
Abstract
Recently, several scaffolds have been introduced for urethral tissue engineering. However, acellular human urethral scaffold harvested from deceased donors may provide significant advantages compared to synthetic, composite, or other biological scaffolds. This study aims to develop the protocol for decellularization of the human urethra that preserves substantial extracellular matrix (ECM) components, which are essential for subsequent recellularization mimicking the natural environment of the native ECM. A total of 12 human urethras were harvested from deceased donors. An equal part of every harvested urethra was used as a control sample for analyses. The protocol design was based on the enzyme-detergent-enzyme method. Trypsin and Triton X-100 were used to remove cells, followed by DNase treatment to remove DNA residues. Subsequently, the specimens were continually rinsed in deionized water for seven days. The efficiency of decellularization was determined by histochemistry, immunohistochemical staining, scanning electron microscopy (SEM), and DNA quantification. Histological analysis confirmed cell removal and preservation of urethral structure after decellularization. The preservation of collagen IV and fibronectin was confirmed by histologic examination and immunohistochemical staining. SEM confirmed the maintenance of the ultrastructural architecture of ECM and fibers. DNA content in decellularized urethra was significantly lower compared to the native sample (P < 0.001), and so the criteria for decellularized tissue were met. Cytotoxicity analysis data showed that the matrix-conditioned medium did not contain soluble toxins and had no significant inhibitory effect on cell proliferation, providing evidence that the decellularized samples are not toxic. This study demonstrates the feasibility of the enzyme-detergent-enzyme-based decellularization protocol for removing cellular components and maintaining urethral ECM and its ultrastructure. Moreover, obtained results provide solid ground for recellularization and urethral tissue engineering, which will follow.
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Affiliation(s)
- Marcela Kuniakova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava 811 08, Slovakia
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
| | - Martin Klein
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Paulina Galfiova
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Maria Csobonyeiova
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Claudia Feitscherova
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Stefan Polak
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Zuzana Varchulova Novakova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava 811 08, Slovakia
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
| | - Katarina Topoliova
- Department of Urology, Faculty of Medicine, Comenius University Bratislava, Bratislava 833 05, Slovakia
| | - Branislav Trebaticky
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Department of Urology, Faculty of Medicine, Comenius University Bratislava, Bratislava 833 05, Slovakia
| | - Ivan Varga
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava 811 08, Slovakia
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
| | - Stanislav Ziaran
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Department of Urology, Faculty of Medicine, Comenius University Bratislava, Bratislava 833 05, Slovakia
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Soliman C, Pan HYC, Mulholland CJ, Furrer MA, Agarwal DK, Lawrentschuk N, Sathianathen NJ. Effect of local steroids on urethral strictures: A systematic review and meta-analysis. Investig Clin Urol 2022; 63:273-284. [PMID: 35534216 PMCID: PMC9091821 DOI: 10.4111/icu.20210391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/20/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Urethral stricture disease is common and has high associated morbidity and impact on quality-of-life. This systematic review and meta-analysis aims to summarise current evidence on the efficacy of local urethral steroids post-direct vision internal urethrotomy (DVIU) for the treatment of urethral strictures in males. MATERIALS AND METHODS A comprehensive search was performed using reputable databases and registries, up to 22 February 2022. Only randomised control trials in which participants were randomised to DVIU plus local urethral steroids versus DVIU only were included. Statistical analyses were performed using a random-effects model. Quality of evidence was rated according to the GRADE approach. RESULTS The search identified seven studies in which 365 participants were randomised to DVIU plus local urethral steroids versus DVIU only. The application of local steroids appeared to reduce recurrence rates (risk ratio, 0.67; 95% confidence interval [CI], 0.49-0.90) and time-to-recurrence (hazard ratio, 0.58; 95% CI, 0.39-0.85). Qmax also improved following steroid application (mean difference, 0.82; 95% CI, -1.02-2.66); however, this was not statistically significant. No heterogeneity was identified between included studies for all outcomes. The certainty of evidence was downgraded due to study limitations with a small sample size and unclear risk-of-bias related to insufficient trial information. CONCLUSIONS Compared to DVIU alone, adjuvant steroids applied to the urethra may reduce risk of recurrence and time-to-recurrence. These findings were statistically significant and likely also clinically significant given low associated costs and risk. However, more robust randomised trials are necessary to enhance the validity of these outcomes.
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Affiliation(s)
- Christopher Soliman
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Henry Y C Pan
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Clancy J Mulholland
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Marc A Furrer
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Dinesh K Agarwal
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Nathan Lawrentschuk
- Department of Urology, The Royal Melbourne Hospital, Parkville, VIC, Australia
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Tissue Engineering of the Urethra: From Bench to Bedside. Biomedicines 2021; 9:biomedicines9121917. [PMID: 34944733 PMCID: PMC8698949 DOI: 10.3390/biomedicines9121917] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Tissue engineering (TE) is a promising approach for repair/substitution of damaged tissues and organs. Urethral strictures are common and serious health conditions that impair quality of life and may lead to serious organ damage. The search for ideal materials for urethral repair has led to interest of scientists and surgeons in urethral TE. Over the last decades, a significant amount of preclinical studies and considerable progress have been observed. In contrast, urethral TE has made slow progress in clinical practice so far. To address this, we conducted a systematic review of the literature on clinical applications of TE constructs for urethral repair in the last three decades. In summary, the TE approach is promising and effective, but many issues remain that need to be addressed for broader adoption of TE in urethral repair. Better design of trials, better cooperation of research groups and centralization could lead to reduction of costs and slowly proceed to commercialization and routine use of TE products for urethral reconstruction.
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Kulkarni SB, Pathak H, Khanna S, Choubey S. A prospective, multi-center, open-label, single-arm phase 2b study of autologous adult live cultured buccal epithelial cells (AALBEC) in the treatment of bulbar urethral stricture. World J Urol 2020; 39:2081-2087. [PMID: 32929625 DOI: 10.1007/s00345-020-03415-5] [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: 05/28/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of autologous adult live cultured buccal epithelial cells (AALBEC) in treatment and management of bulbar urethral stricture in men. METHODS This was a prospective, multi-center, open-label, single-arm phase 2b study. A total of 18 male patients with bulbar urethral stricture of at least 1 - 4 cm in length were enrolled in the study. All 16 patients had AALBEC implanted and were included in the safety set. Change in total American Urology Association (AUA) symptom score, urinary flow rates assessed by uroflowmetry and a requirement for surgery after 24 weeks from baseline were determined in patients. Data of treatment efficacy were analyzed. RESULTS The AUA score at baseline was 21 (3.9) that showed a statistically significant reduction starting from week 2 [8 (4.4), p = 0.0001] which sustained until week 24 [2 (1.2), p = 0.0005]. Overall mean total AUA symptom score was reduced by 90.5% after the treatment. Significant reductions from baseline at week-24 were also observed in voiding time (92.5 (47.3) vs. 51.9 (17.4) s, p = 0.0046) and flow time [86.9 (48.2) vs. 47.9 (19.6) s, p = 0.0052]. All patients showed absence of any significant adverse events. CONCLUSION Significant improvement was seen in the AUA symptom score and uroflowmetry parameters and no patients required surgery during 24 weeks post-treatment. It can be concluded that AALBEC is a safe and effective treatment for bulbar urethral stricture of 1 - 4 cm length to improve the quality of life and the physiological function of urethra.
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Affiliation(s)
- Sanjay B Kulkarni
- Kulkarni Endo Surgery Institute and Reconstructive Urology Centre, Pune, India.
| | - Hemant Pathak
- TNMC Medical College and B. Y. L. Nair Charitable Hospital, Leelavati Hospital, Mumbai, India
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Bugeja S, Payne SR, Eardley I, Mundy AR. The standard for the management of male urethral strictures in the UK: a consensus document. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820933504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The aim of this study was to establish an evidence-based best clinical practice consensus for the management of urethral stricture disease in the UK. Methods: A systematic review of optimal management of urethral stricture generated a base document which was endorsed by the British Association of Urological Surgeons (BAUS) section of Andrology and Genito-Urinary Reconstructive Surgeons (AGUS). A two-round electronic mail modified Delphi survey of 43 consultant reconstructive urologists, members of the British Association of Genito-Urinary Reconstructive Surgeons (BAGURS), was then performed. The panel’s views about the base document was sought in seven domains: definition, diagnosis, investigation, conservative, endoscopic and reconstructive treatments, and follow up. Responses were collated and used to modify the base to achieve a consensus statement. Results: In round one of the Delphi process four panel members commented on the base document and seven in round two. Consensus was thereby reached on 38 statements regarding definition (one), diagnosis (three), investigation (two), conservative/endoscopic (five) and reconstructive (24) treatments and follow up (three) for the management of urethral stricture disease. Conclusion: This consensus statement will help standardise care, provide guidance on the management of urethral stricture disease, and assist in clinical decision-making for healthcare professionals of all grades.
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Affiliation(s)
- Simon Bugeja
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Anthony R. Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
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12
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Rourke KF, Welk B, Kodama R, Bailly G, Davies T, Santesso N, Violette PD. Canadian Urological Association guideline on male urethral stricture. Can Urol Assoc J 2020; 14:305-316. [PMID: 33275550 DOI: 10.5489/cuaj.6792] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Urethral stricture is fundamentally a fibrosis of the urethral epithelial and associated corpus spongiosum, which in turn, causes obstruction of the urethral lumen. Patients with urethral stricture most commonly present with lower urinary tract symptoms, urinary retention or urinary tract infection but may also experience a broad spectrum of other signs and symptoms, including genitourinary pain, hematuria, abscess, ejaculatory dysfunction, or renal failure. When urethral stricture is initially suspected based on clinical assessment, cystoscopy is suggested as the modality that most accurately establishes the diagnosis. This recommendation is based on several factors, including the accuracy of cystoscopy, as well as its wide availability, lesser overall cost, and comfort of urologists with this technique. When recurrent urethral stricture is suspected, we suggest performing retrograde urethrography to further stage the length and location of the stricture or referring the patient to a physician with expertise in reconstructive urology. Ultimately, the treatment decision depends on several factors, including the type and acuity of patient symptoms, the presence of complications, prior interventions, and the overall impact of the urethral stricture on the patient's quality of life. Endoscopic treatment, either as dilation or internal urethrotomy, is suggested rather than urethroplasty for the initial treatment of urethral stricture. This recommendation applies to men with undifferentiated urethral stricture and does not apply to trauma-related urethral injuries, penile urethral strictures (hypospadias, lichen sclerosus), or suspected urethral malignancy. In the setting of recurrent urethral stricture, urethroplasty is suggested rather than repeat endoscopic management but this may vary depending on patient preference and impact of the symptoms on the patient.The purpose of this guideline is to provide a practical summary outlining the diagnosis and treatment of urethral stricture in the Canadian setting.
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Affiliation(s)
- Keith F Rourke
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Blayne Welk
- Division of Urology, Western University, London, ON, Canada
| | - Ron Kodama
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Greg Bailly
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Tim Davies
- McMaster University, Hamilton, ON, Canada
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13
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Abstract
This section aims to review general principles of endoscopic management of urethral stricture disease and posterior urethral stenosis, with a special focus on the indications for treatment and technical aspects of urethral dilation and internal incision.
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Affiliation(s)
- James Furr
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, California, USA
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14
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Barbagli G, Fossati N, Montorsi F, Balò S, Rimondi C, Larcher A, Sansalone S, Butnaru D, Lazzeri M. Focus on Internal Urethrotomy as Primary Treatment for Untreated Bulbar Urethral Strictures: Results from a Multivariable Analysis. Eur Urol Focus 2020; 6:164-169. [DOI: 10.1016/j.euf.2018.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 09/16/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
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15
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Scott KA, Li G, Manwaring J, Nikolavsky DA, Fudym Y, Caza T, Badar Z, Taylor N, Bratslavsky G, Kotula L, Nikolavsky D. Liquid buccal mucosa graft endoscopic urethroplasty: a validation animal study. World J Urol 2019; 38:2139-2145. [PMID: 31175459 DOI: 10.1007/s00345-019-02840-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/03/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To validate a novel method of urethral stricture treatment using liquid buccal mucosal grafts (LBMG) to augment direct vision internal urethrotomy (DVIU) in an animal model. MATERIALS AND METHODS A rabbit stricture model was used to test this method. Strictures were induced in 26 rabbits using electroresection of urethral epithelium. The animals were randomized into two groups: Group-1, treated with DVIU and LBMG in fibrin glue, and Group-2, DVIU with fibrin glue only. LBMG was prepared by suspension of mechanically minced buccal mucosa micrografts in fibrin glue. This LBMG-fibrin glue mixture was later injected into the urethrotomies of Group-1 animals. All animals were killed at 24 weeks after repeat retrograde urethrogram (RUG) and urethroscopy by surgeon blinded to the treatment arm. Radiographic images and histological specimens were reviewed by a radiologist and a pathologist, respectively, blinded to the treatment arm. Stricture treatment was considered a success if a diameter measured on RUG increased by ≥ 50% compared to pre-treatment RUG diameter. Histological specimens were assessed for the presence of BMG engraftment. RESULTS In Group-1, 8/12(67%) animals demonstrated engraftment of LBMG, compared to none in Group-2 (p = 0.0005). 7/12(58%) in Group-1 showed radiographic resolution/improvement of strictures compared to 5/13 Group-2 rabbits (38%, p = 0.145). The median percent change for the Group-1 was 59%, compared to 41.6% for Group-2 (p = 0.29). CONCLUSION This proof-of-concept study demonstrates feasibility of LBMG for endoscopic urethral stricture repairs. Further studies are needed to establish the role of this novel concept in treatment of urethral strictures.
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Affiliation(s)
- Kathryn A Scott
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Guanqun Li
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Jared Manwaring
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Daniela A Nikolavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Yelena Fudym
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Tiffany Caza
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Zain Badar
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Nicole Taylor
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Gennady Bratslavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Leszek Kotula
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Dmitriy Nikolavsky
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA.
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16
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A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9046430. [PMID: 31139658 PMCID: PMC6500724 DOI: 10.1155/2019/9046430] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/31/2019] [Indexed: 12/21/2022]
Abstract
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.
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17
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Fuehner C, Dahlem R, Fisch M, Vetterlein MW. Update on managing anterior urethral strictures. Indian J Urol 2019; 35:94-100. [PMID: 31000913 PMCID: PMC6458800 DOI: 10.4103/iju.iju_52_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023] Open
Abstract
A number of techniques have been described for managing anterior urethral strictures in men. In this review, we aimed to summarize contemporary considerations regarding the holistic management of such strictures. The efficacy of reported outcomes is compared to provide evidence-based treatment recommendations. For anterior urethral strictures, durable long-term success rates of >90% may be achieved if the procedure is performed in capable hands at a high-volume referral center, even in recurrent strictures after previous open reconstruction. A one-stage urethroplasty is preferable to avoid a protracted treatment course with multiple interventions after dilation and direct vision internal urethrotomy. Staged urethroplasties are useful in complex anterior strictures providing durable success rates. In addition, perineal urethrostomy represents a valid last resort option with sufficient objective and subjective results. A follow-up evaluation should incorporate objective assessments such as radiographic and functional diagnostics as well as subjective, validated, and disease-specific patient-reported outcome measurement tools to allow for a better comparability and to improve individual risk prediction.
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Affiliation(s)
- Constantin Fuehner
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W. Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Tonnhofer U, Hiess M, Metzelder M, Hebenstreit D, Springer A. Midline Incision of a Graft in Staged Hypospadias Repair-Feasible and Durable? Front Pediatr 2019; 7:60. [PMID: 30931285 PMCID: PMC6423900 DOI: 10.3389/fped.2019.00060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/14/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose: In severe hypospadias staged repair is commonly used and it is regarded as feasible, safe, and durable. In this article we want to describe the results of a modification of the staged repair: a midline incision of the graft during the second stage. Materials and Methods: This is a consecutive single team (2 surgeons) retrospective series. Between 2014 and 2017, 250 patients underwent hypospadias repair, among them 35 patients that had primary staged hypospadias surgery with completed first and second stage repair. 24 (68.6%) cases received a preputial skin graft and 11 (31.4%) buccal mucosa graft. Median age at first stage was 1.5 (0.5-22.1) years, mean time between first and second stage operation was 0.72 (0.4-1.76) years. Follow up rate was 100%, mean follow up period was 1.50 (0.4-3.8) years. Results: The total complication rate was 22.9%. In buccal mucosa repair the complication rate was 36.4% and in preputial graft repair the complication rate was 16.7%, respectively. In 23 patients (65.7%) during second stage urethroplasty a midline incision was performed (8 glandular graft, 15 penile graft, 6 at level of urethral opening). Complication rate in non-incised urethroplasty was 8.3%, in incision at glandular level 37.5%, in incision at penile level 13.3% and in incision at urethral opening 16.7%, respectively. Conclusions: Two stage repair is the method of choice in the correction of severe hypospadias. In selected cases a midline incision of the graft is feasible and can be applied if needed. Randomized studies will be needed to evaluate the true benefit of incising the graft.
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Affiliation(s)
- Ursula Tonnhofer
- Department of Pediatric Surgery, Medical University Vienna, Vienna, Austria
| | - Manuela Hiess
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Martin Metzelder
- Department of Pediatric Surgery, Medical University Vienna, Vienna, Austria
| | - Doris Hebenstreit
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Alexander Springer
- Department of Pediatric Surgery, Medical University Vienna, Vienna, Austria
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19
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Female urethroplasty: contemporary thinking. World J Urol 2018; 37:619-629. [DOI: 10.1007/s00345-018-2564-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/10/2018] [Indexed: 11/26/2022] Open
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20
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Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease. Curr Urol Rep 2018; 19:19. [PMID: 29479640 DOI: 10.1007/s11934-018-0771-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Male urethral stricture disease is characterized by the formation of scar tissue within the urethra resulting in lower urinary tract symptoms, infection, and potentially kidney dysfunction. There is significant variability in clinical practice for the treatment of urethral stricture. We sought to summarize the known data on endoscopic management of urethral stricture disease as part of this larger edition on urethral stricture management. RECENT FINDINGS Older studies quoted high rates of success with endoscopic management of urethral stricture, including repeated DVIU. There is now evidence to support a limited role of endoscopic intervention in the management of urethral stricture, and especially strong evidence that repeated endoscopic procedures are not effective. There is poor evidence to support the long-term efficacy of endoscopic urethral stricture management. Furthermore, novel advances in adjunctive therapies have not yet demonstrated durable patency. We discuss the limited role of endoscopic management and suggest an algorithm for its use in stricture management.
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21
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Silagy A, Merrett C, Agarwal D. Initial experience with Allium™ stent in the management of bulbar urethral stricture. Transl Androl Urol 2017; 6:S88-S91. [PMID: 28791227 PMCID: PMC5522800 DOI: 10.21037/tau.2017.04.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
We herein present our initial experience of a short series with the Allium™ Bulbar Urethral Stent (BUS) in the management of bulbar urethral disease. This Allium™ stent is a self-expandable metal stent which is intended for temporary placement. Our series is a retrospective analysis of 15 BUS placements in 13 patients conducted during 2014 to 2016. BUS was placed successfully after visual internal urethrotomy (VIU) in all patients. Stent insertion was successful in 8 patients (62%) with a mean follow up of 7.2 months (range, 2–12 months). Two of the failed patients stents were reinserted had repeat stenting with a successful outcome. The result of this short series suggests that BUS may have a limited role in the management of bulbar urethral stricture disease.
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Affiliation(s)
- Andrew Silagy
- Epworth Richmond, Epworth HealthCare, Richmond VIC 3121, Australia.,Footscray Hospital, Western Health, Footscray 3011, Australia.,The Royal Melbourne Hospital, Melbourne Health, Parkville VIC 3050, Australia
| | - Chris Merrett
- Epworth Richmond, Epworth HealthCare, Richmond VIC 3121, Australia.,Footscray Hospital, Western Health, Footscray 3011, Australia.,The Royal Melbourne Hospital, Melbourne Health, Parkville VIC 3050, Australia
| | - Dinesh Agarwal
- Epworth Richmond, Epworth HealthCare, Richmond VIC 3121, Australia.,Footscray Hospital, Western Health, Footscray 3011, Australia.,The Royal Melbourne Hospital, Melbourne Health, Parkville VIC 3050, Australia
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Bayne DB, Gaither TW, Awad MA, Murphy GP, Osterberg EC, Breyer BN. Guidelines of guidelines: a review of urethral stricture evaluation, management, and follow-up. Transl Androl Urol 2017; 6:288-294. [PMID: 28540238 PMCID: PMC5422698 DOI: 10.21037/tau.2017.03.55] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/21/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Our objective is to report a comparative review of recently released guidelines for the evaluation, management, and follow-up of urethral stricture disease. METHODS This is an analysis of the American Urologic Association (AUA) and Société Internationale d'Urologie (SIU) guidelines on urethral stricture. Strength of recommendations is stratified according to letter grade that corresponds to the level of evidence provided by the literature. RESULTS Although few, the discrepancies between the recommendations offered by the two guidelines can be best explained by varying interpretations of the literature and available evidence on urethral strictures. When comparing the AUA guidelines and the SIU guidelines on urethral stricture, there are very few discrepancies. Perhaps the most notable difference is in the use of repeat DVIU or urethral dilation after an initial failed attempt. SIU guidelines state that there are instances where repeat DVIU or urethral dilation can be indicated, and they give a range of time at which stricture recurrence post procedure mandates an urethroplasty (less than 3 to 6 months). The AUA guidelines definitively state that repeat endoscopic procedures should not be offered as an alternative to urethroplasty, and they do not mention time of stricture recurrence as a factor. SIU guidelines allow for management of urethral stricture with indwelling urethral stenting. CONCLUSIONS Overall there is a need for more high quality research in the work up, management, and follow up care of urethral stricture.
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Affiliation(s)
- David B. Bayne
- Department of Urology, University of California, San Francisco, USA
| | | | - Mohannad A. Awad
- Department of Urology, University of California, San Francisco, USA
| | | | | | - Benjamin N. Breyer
- Department of Urology, University of California, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
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23
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Novel Concept and Method of Endoscopic Urethral Stricture Treatment Using Liquid Buccal Mucosal Graft. J Urol 2016; 196:1788-1795. [DOI: 10.1016/j.juro.2016.05.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/18/2022]
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