Urethral Stricture Disease Guideline Amendment (2023)

PURPOSE

The symptoms of urethral stricture are non-specific and may overlap with other common conditions that can confound diagnosis. Urologists play a key role in the initial evaluation of urethral stricture, currently provide all accepted treatments, and must be familiar with the evaluation, diagnostic tests, and surgical treatments for urethral stricture.

MATERIALS AND METHODS

A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates January 1, 1990 to January 12, 2015) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of urethral stricture in men. The review yielded an evidence base of 250 articles after application of inclusion/exclusion criteria. The search for the 2023 Amendment was modified to included females and males (search dates December 2015-October 2022 for males; January 1990-October 2022 for females) and a new Key Question on sexual dysfunction was added (search dates: January 1990-10/2022). After inclusion and exclusion criteria were applied, 81 studies were added to the existing evidence base.

RESULTS

Once a urethral stricture is diagnosed, clinicians should determine the length and location of the stricture in order to inform treatment. After a period of urethral rest, patients with short (<2cm) bulbar urethral stricture may be treated endoscopically. Urethroplasty may be performed by an experienced surgeon in patients with first time or recurrent anterior and posterior urethral strictures. The best treatment option for urethral stricture in female patients is urethroplasty using oral mucosa grafts or vaginal flaps rather than endoscopic treatment.

CONCLUSION

This guideline provides evidence-based guidance to clinicians and patients regarding how to recognize symptoms and signs of a urethral stricture/stenosis, carry out appropriate testing to determine the location and severity of the stricture, and recommend the best options for treatment. The most effective approach for a particular patient is best determined by the individual clinician and patient in the context of that patient's history, values, and goals for treatment.

Permanent urethral ligation after AUS cuff erosion: Is it ready for prime time?

AIMS

Although artificial urinary sphincter (AUS) has long been the gold standard treatment for severe stress urinary incontinence, poor tissue quality in patients with prior cuff erosions may preclude this option. Formal supravesical diversion and/or bladder neck closure comprise alternative salvage options but are associated with significant morbidity and mortality. We review our experience with permanent urethral ligation (PUL) among patients deemed not to be candidates for AUS replacement following cuff erosion.

METHODS

From a single-center database of 396 patients undergoing AUS from 2014 to 2020, 20 men underwent PUL with suprapubic tube (SPT) diversion. Clinical characteristics and outcomes were evaluated. Quality of life (QOL) was assessed using chart review, Michigan Incontinence Symptom Index (M-ISI), and Patient Global Impression of Improvement (PGI-I).

RESULTS

PUL resulted in continence in 18 (90%) men; 15 after the initial surgery and three after repeat ligation. Patients were elderly (average age 75) with significant comorbidities. A total of 11 (55.5%) patients experienced complications in the 90-day postoperative period (seven Clavien-Dindo Grade II, four Grade III). Over an average follow-up of 30.3 months (interquartile range: 15.75-48.75), four patients underwent cystectomy and one underwent perineal urethrostomy. In the remaining patients managed by PUL, 13 had satisfactory M-ISI scores and indicated overall improvement on PGI-I.

CONCLUSIONS

For men with AUS cuff erosion who are poor candidates for replacement, PUL with chronic SPT drainage represents an acceptable alternative option to restore continence and improve QOL. Though complications are not uncommon, the morbidity profile still compares favorably to more invasive formal urinary diversion.

Application of optical technologies in the US poultry slaughter facilities for the detection of poultry carcase condemnation

1. This article reviews the studies on optical technologies for automated poultry carcase inspection, discusses challenges and potential solutions in their real-time applications in poultry slaughter facilities. 2. Over the past few decades, extensive research has been underway to develop an optical technology-based machine vision system for automated inspection of poultry carcases and viscera. Such an automated technology will not only aid in carcase inspection to maximise food safety, but it will also support the U.S. New Poultry Inspection System's aim to foster innovation in poultry processing as well as increase line speed. 3. Many earlier studies based on visible and near-infrared spectroscopy showed promise, but could not be implemented successfully in an on-line poultry processing plant. Currently, multi- and hyper-spectral imaging-based machine vision systems have shown promising outcomes. 5. The critical hurdles for real-time application of automated imaging technology in poultry carcase inspection include high-speed processing lines, slaughter facilities environment and variation in broiler rearing practices. Therefore, further improvement in imaging and machine vision technologies based on physiochemical properties on poultry carcases, the establishment of more technology friendly inspection station, and an integrated data management for different rearing practices are essential to overcome those hurdles.

Antimicrobial Interventions in Poultry Processing to Improve Shelf Life and Safety of Poultry Meat: A Review with Special Attention to Salmonella spp

Poultry meat is one of the most popularly consumed meats worldwide. With the increased consumption, the poultry industry is also facing major challenges in maintaining of safety and shelf life of the poultry meat. Microbial concerns related to poultry meat comprise of meat safety and shelf life as poultry meat is prone to contamination with spoilage as well as pathogenic microorganisms. Poultry may be contaminated with pathogenic microorganisms such as Salmonella spp. at various processing steps, posing significant health risk to the consumers. To reduce the predominance of food-borne pathogens such as Salmonella spp. as well as spoilage microorganisms, poultry processors can employ a multi-hurdle approach wherein antimicrobial interventions are applied at various steps of processing. This article reviewed different poultry processing steps and the antimicrobial interventions used in the poultry processing sector to improve safety, shelf life, and quality of poultry meat. This review provides comprehensive knowledge on safety of poultry meat with special attention to Salmonella spp. for the poultry industry as well as researchers throughout the world.

Success of Penile Replantation Using Combination of Cialis, Hyperbaric Oxygen, and SPY Technology

Objective: There are very few studies reporting the techniques utilized in penile replantation. Of those in literature, many agree that the use of microvascular technique results in better outcomes. The most common complications are skin necrosis and venous congestion, which are even higher in replants without arterial supply. Methods: This study describes a case of self-inflicted penile amputation treated with microsurgical replantation and managed postoperatively with hyperbaric oxygen therapy and Cialis (tadalafil), and SPY angiography. The penile replant had extensive skin necrosis, which prevented a sufficient clinical evaluation of the replanted penis. Serial SPY angiography was performed to assess tissue viability, following hyperbaric oxygen therapy and Cialis treatment. Results: SPY angiography was critical to the decision making of the operating team in the management of this case of penile replantation. Conclusions: The use of SPY angiography prevented the patient from undergoing revision amputation and allowed for a safe and successful penile replantation.

Curve of Perceptive Intellectual Deterioration in Hemodialysis Patients

In order to optimize the results of kidney transplant, i.e. patient's acceptance and speedy recovery, the available organ resources must be combined with appropriate “preparation” of the patient's mental state. In order to plot the “mental deterioration curve” of patients on a hemodialysis program, the present study was made on 62 patients in a general hospital in Spain. The possible repercussions of treatment of kidney disease on intellectual (Weschler's Adult Intelligence Scale-WAIS test) and perceptive (Benton test) capacity were investigated. Samples were grouped according to whether they had been on dialysis for up to four years (<4) or more than four years (>4). The WAIS test for the >4 group indicated a lower I.Q. These results indicated that it was after four years on dialysis that greater negative effects began to be seen in perceptive-intellectual capacity. The Benton test indicated that time on hemodialysis adversely affected the patient's capacities. A sharp decline was seen particularly between two and four years in the <4 group, suggesting that patients’ mental conditions vary with time on dialysis but that their resources and capacities are still fairly untroubled by the treatment in the first two years. In the light of these findings, the deterioration curve should be taken into account when planning kidney transplant, in order to take advantage of the initial period if possible.

External Mechanical Devices and Vascular Surgery for Erectile Dysfunction

INTRODUCTION

The field of sexual medicine is continuously advancing, with novel outcomes reported on a regular basis. Given the rapid evolution, updated guidelines are essential to inform practicing clinicians on best practices.

AIM

To summarize the current literature and provide clinical guidelines on penile traction therapy, vacuum erection devices, and penile revascularization.

METHODS

A consensus panel was held with leading sexual medicine experts during the 2015 International Consultation on Sexual Medicine (ICSM). Relevant literature was reviewed and graded based on Oxford criteria to develop evidence-based guideline and consensus statements.

MAIN OUTCOME MEASURES

The development of clinically relevant guidelines.

RESULTS

Penile traction therapy is a viable therapy to modestly improve penile length as a primary therapy, before penile prosthesis placement in men with decreased penile length or after surgery for Peyronie's disease. It also might have a role in the acute phase of Peyronie's disease but has inconsistent outcomes in the long-term phase. Vacuum erection devices are effective in creating an erection satisfactory for intercourse, even in difficult-to-treat populations. They also might be used in the post-prostatectomy setting to maintain penile length but have insufficient evidence as a penile rehabilitation therapy. For vasculogenic erectile dysfunction, men with suspected arterial insufficiency can be evaluated with penile Duplex Doppler ultrasonography and confirmatory angiography. Penile revascularization procedures have consistently demonstrated benefits in very select patient populations; however, inadequate data exists to suggest the superiority of one technique. Men with vascular risk factors are likely poor candidates for penile revascularization, although veno-occlusive dysfunction and age are less significant. Therapies for treating primary veno-occlusive dysfunction are not recommended and should be reserved for clinical trials.

CONCLUSIONS

Since the prior ICSM meeting, multiple developments have occurred in external mechanical devices and penile revascularization for the treatment of erectile and sexual dysfunction. Sexual medicine clinicians are encouraged to review and incorporate recommendations as applicable to their scope of practice.

Male Stress Incontinence Grading Scale (MSIGS) for Evaluation of Men with Post-Prostatectomy Incontinence: A Pilot Study

INTRODUCTION

We developed an objective clinical grading scale to characterize post-prostatectomy incontinence (PPI) and evaluated its use as a tool to facilitate male anti-incontinence procedure selection.

PROTOCOL

Between September 2014 and July 2015, we prospectively implemented a novel Male Stress Incontinence Grading Scale (MSIGS) to stratify PPI patients based on incontinence severity. Patients included were those referred for PPI who had no prior anti-incontinence surgery. During the initial outpatient consultation, each patient was prospectively assigned an incontinence grade score of 0 through 4 based on the consensus of 2 examiners performing a standing cough test (SCT). All patients refrained from voiding for at least 60 minutes prior to the SCT. Men with mild SUI (MSIGS grades 0-2) were offered AdVance sling surgery while those with heavier SUI (MSIGS grades 3-4) were offered artificial urinary sphincter (AUS). MSIGS grade was correlated to patient-reported pads-per-day (PPD), and patient-reported outcomes of anti-incontinence surgery were assessed.

OUTCOME

Of 62 consecutive new PPI patients, 20 were graded as mild based on SCT [five (8%) grade 0, 10 (16%) grade 1, five (8%) grade 2] while 42 were graded as moderate-severe [10 (16%) grade 3, 32 (52%) grade 4]. MSIGS grade demonstrated a strong correlation with preoperative PPD (r=0.74). Among the 53 patients who underwent surgical intervention for PPI, 14 with mild SUI were treated with AdVance® male urethral sling (MSIGS grade 0, 1, or 2) while 39 more severe cases received AUS (MSIGS grade 3 or 4). Patient-reported improvement was high overall (median 95%) and similar for sling and AUS patients (95% and 96.5% respectively, p=0.596). The median time from radical prostatectomy to anti-incontinence surgery was 5.4 years (range 1-20).

DISCUSSION

The Male Stress Incontinence Grading Scale provides a rapid, simple, non-invasive, objective assessment of PPI severity which strongly correlates with patient-reported pads-per-day and appears to facilitate anti-incontinence surgical procedure selection.

Effect of liquid smoke as an ingredient in frankfurters on Listeria monocytogenes and quality attributes

Market trends indicate an increased interest in natural antimicrobials to augment safety of ready-to-eat meat and poultry products against Listeria monocytogenes. Liquid smoke, an all-natural condensate of smoke components, applied as a postprocess treatment on product surface has the potential to exhibit antilisterial properties. Studies on its antimicrobial efficacy and quality attributes as an ingredient are not sufficient. A study was designed to validate the antimicrobial effect of liquid smoke as an ingredient against L. monocytogenes and its effect on the shelf life and quality of frankfurters. Chicken/pork frankfurters were incorporated with 0, 2.5, 5, and 10% liquid smoke (Zesti Smoke, Kerry Ingredients and Flavors, TN). Cooked casing-stripped frankfurters (4 per package) were placed in vacuum-pack bags, spray inoculated with either high (8 log(10) cfu/ mL) or low (4 log(10) cfu/ mL) levels of L. monocytogenes serotype 4b, vacuum packaged, and stored at 4°C for up to 12 wk. Samples were taken every week for 12 wk to estimate growth of L. monocytogenes and spoilage microflora (aerobic plate counts, yeast and molds, lactic acid bacteria, and total coliforms) and properties of sensory scores and texture profile analysis. The experiment was conducted as 3 separate trials and data was analyzed to find significant differences at P < 0.05. Formulation of frankfurters with smoke extract at 2.5, 5, and 10% reduced (P < 0.05) populations of L. monocytogenes as compared with the controls throughout the storage period irrespective of the inoculation levels. Furthermore, incorporation of smoke extract did not affect (P > 0.05) the texture, juiciness, flavor, and overall scores as well as hardness and chewiness of the frankfurters. Zesti Smoke can be effectively incorporated as an all-natural antimicrobial in the manufacture of frankfurters without negatively affecting quality attributes.