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Klemm J, Dahlem R, Kluth LA, Rosenbaum CM, Shariat SF, Fisch M, Vetterlein MW. [Evaluation and management of urethral strictures-guideline summary 2024 : Part 2-posterior urethra]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:15-24. [PMID: 38057615 DOI: 10.1007/s00120-023-02241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 12/08/2023]
Abstract
In light of recently published international guidelines concerning the diagnosis, treatment, and aftercare of urethral strictures and stenoses, the objective of this study was to synthesize an overview of guideline recommendations provided by the American Urological Association (AUA, 2023), the Société Internationale d'Urologie (SIU, 2010), and the European Association of Urology (EAU, 2023). The recommendations offered by these three associations, as well as the guidelines addressing urethral trauma from the EAU, AUA, and the Urological Society of India (USI), were assessed in terms of their guidance on posterior urethral stenosis. On the whole, the recommendations from the various guidelines exhibit considerable alignment. However, SIU and EAU place a stronger emphasis on the role of repeated endoscopic treatment compared to AUA. The preferred approach for managing radiation-induced bulbomembranous stenosis remains a subject of debate. Furthermore, endoscopic treatments enhanced with intralesional therapies may potentially serve as a significant treatment modality for addressing even fully obliterated stenoses.
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Affiliation(s)
- Jakob Klemm
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
- Comprehensive Cancer Center, Medizinische Universität Wien, Universitätsklinik für Urologie, Wien, Österreich
| | - Roland Dahlem
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Luis A Kluth
- Klinik für Urologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland
| | | | - Shahrokh F Shariat
- Comprehensive Cancer Center, Medizinische Universität Wien, Universitätsklinik für Urologie, Wien, Österreich
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordanien
- Karl Landsteiner Institut für Urologie und Andrologie, Wien, Österreich
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prag, Tschechien
| | - Margit Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Malte W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Klemm J, Dahlem R, Kluth LA, Rosenbaum CM, Shariat SF, Fisch M, Vetterlein MW. [Evaluation and management of urethral strictures-guideline summary 2024 : part 1-anterior urethra]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:3-14. [PMID: 38153427 DOI: 10.1007/s00120-023-02240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 12/29/2023]
Abstract
In recent years, several international urological societies have published guidelines on the diagnosis, treatment, and follow-up of urethral strictures, but a guideline for the German-speaking region has not been available to date. This summary provides a detailed comparison of the guidelines of the European Association of Urology (EAU), American Urological Association (AUA) and the Société Internationale d'Urologie (SIU) with regard to the treatment of anterior urethral strictures, i.e. from the bulbar urethra to the meatus. In the following work, differences and specific recommendations in the guidelines are highlighted. In particular, the three guidelines largely agree with regard to diagnostic workup and follow-up. However, divergences exist in the management of anterior urethral strictures, particularly with regard to the use of endoscopic therapeutic approaches and the use of urethral stents. In addition, the EAU provides more comprehensive and detailed recommendations on urethroplasty techniques and specific patient follow-up. The EAU guidelines are the most current and were the first to include instructions for urethral strictures in women and individuals with gender incongruence after genital approximation surgery. Reconstructive urology is a rapidly evolving specialty and, thus, the clinical approach has been changing accordingly. Although guideline recommendations have become more inclusive and comprehensive, more high-quality data are needed to further improve the level of evidence.
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Affiliation(s)
- Jakob Klemm
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
- Universitätsklinik für Urologie, Comprehensive Cancer Center, Medizinische Universität Wien, Wien, Österreich
| | - Roland Dahlem
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Luis A Kluth
- Klinik für Urologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Deutschland
| | | | - Shahrokh F Shariat
- Universitätsklinik für Urologie, Comprehensive Cancer Center, Medizinische Universität Wien, Wien, Österreich
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordanien
- Karl Landsteiner Institut für Urologie und Andrologie, Wien, Österreich
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prag, Tschechien
| | - Margit Fisch
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Malte W Vetterlein
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Akyuz M, Ozsoy E, Tokuc E, Artuk I, Kayar R, Bastug Y, Öztürk Mİ. Management and outcomes of urethral stricture: single centre experience over 13 years. Aktuelle Urol 2023; 54:482-486. [PMID: 36002031 DOI: 10.1055/a-1904-6943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AIM To present a comprehensive summary of the diagnosis, treatment and follow-up process of patients who underwent open urethroplasty in our tertiary referral center for the treatment of urethral stricture in the last 13 years. MATERIALS AND METHODS Two hundred and forty-five (245) patients who underwent open urethroplasty between January 2008 and June 2021 were retrospectively analysed. Detailed history, physical examination, uroflowmetry, retrograde urethrography and/or voiding cystourethrography and/or urethroscopy were used throughout the preoperative diagnosis process. While evaluating the postoperative patency rates, the absence of preoperative voiding symptoms after the operation and Qmax 15 ml/sec and above were taken into account. RESULTS Mean stricture length was 3.8 +/- 1.4 cm. Transurethral endoscopic interventions in 79 patients (32.2%), catheterisation in 55 patients (22.4%), trauma in 54 patients (22%), infection in 15 patients (6.2%), and idiopathology in 42 patients (17.2%) were the causes for the stricture. Buccal mucosal graft was used in 125 patients (51%), penile skin flap in 32 patients (13%), end-to-end anastomosis in 83 patients (33.8%) and Heineke-Mikulicz technique in 5 patients (2%). Mean follow-up period was 67.1 +/- 28.9 months. Success rates of patients were 84% (105) in buccal mucosal graft, 78.1% (25) in penile skin flap, 86.7% (72) with end-to-end anastomosis and 80% (4) with Heineke-Mikulicz technique. CONCLUSION Among treatment options for urethral stricture, urethroplasty techniques is the most successful treatment. Consideration of the factors leading to the formation of the stricture, with the intraoperative findings and surgical experience will maximize the benefit the patient receives.
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Affiliation(s)
- Mehmet Akyuz
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Emrah Ozsoy
- Urology, Ünye Çakırtepe Hospital, Ordu, Turkey
| | - Emre Tokuc
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ilker Artuk
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ridvan Kayar
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Bastug
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Metin İshak Öztürk
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Female urethral stricture: which one is stronger? Labial vs buccal graft. Int Urogynecol J 2022; 33:731-735. [PMID: 35039917 DOI: 10.1007/s00192-021-05052-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to compare labial and buccal mucosa graft methods in female urethroplasty. METHODS Female urethroplasty surgeries performed between March 2016 and October 2020 were retrospectively reviewed. Labial and buccal mucosa graft surgeries were listed. RESULTS Between March 2016 and October 2020, a total of 28 patients had graft urethroplasty surgery in our center. Fourteen had labial, 14 had buccal onlay graft urethroplasty. The pre-treatment Qmax values were 13 ml/s in the labia major onlay graft (LMOG) group and 12.5 ml/s in the buccal mucosa onlay graft (BMOG) group. The Qmax values after the treatment were remeasured at the 1st, 3rd, and 12th months. They were 20 ml/s, 24 ml/s, and 24 ml/s in the LMOG group and 23 ml/s, 25 ml/s, and 28 ml/s in the BMOG group. The operation times were 65 min (55-90) in the LMOG group; in the BMOG group, it was 70.35 min (65-90). CONCLUSIONS In female urethral strictures, especially in long segments and recurrent strictures, graft urethroplasty is a successful and safe method. Dorsal buccal onlay mucosal graft and labia major grafts show similar results in the early period to complications and success. In the long term, buccal onlay mucosal graft gives better results.
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