Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference?

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.

Tissue engineered indigenous pericardial patch urethroplasty: A promising solution to a nagging problem

Objective

Urethral stricture is a highly prevalent disease and has a continued rising incidence. The global burden of disease keeps rising as there are significant rates of recurrence with the existing management options with the need for additional repeat procedures. Moreover, the existing treatment options are associated with significant morbidity in the patient. Long segment urethral strictures are most commonly managed by augmentation urethroplasty. We explored the potential for the application of an acellular tissue engineered bovine pericardial patch in augmentation urethroplasty in a series of our patients suffering from urethral stricture disease. The decreased morbidity due to the avoidance of harvest of buccal mucosa, decreased operative time and satisfactory postoperative results make it a promising option for augmentation urethroplasty.

Methods

Nine patients with long segment anterior urethral strictures (involving penile and/or bulbar urethra and stricture length >4 cm) were included in the study after proper informed consent was obtained. Acellular tissue engineered indigenous bovine pericardial patch was used for urethroplasty using dorsal onlay technique.

Results

A total of nine patients underwent tissue engineered indigenous pericardial patch urethroplasty for long segment urethral strictures, mostly catheter injury induced or associated with balanitis xerotica obliterans. Median follow-up was 8 months (range: 2–12 months). Out of nine patients, eight (88.9%) were classified as success and one (11.1%) was classified as failure.

Conclusion

Our study brings a product of tissue engineering, already being used in the cardiovascular surgery domain, into the urological surgery operating room with satisfactory results achieved using standard operating techniques of one stage urethroplasty.

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

Objective

To report the surgical details and results of our technique of buccal mucosal graft (BMG) urethroplasty for panurethral stricture, as many studies have reported repair of panurethral stricture by single-stage BMG urethroplasty by placing buccal mucosa ventrally, dorsally or dorsolaterally.

Patients and methods

This was an observational analysis of 38 patients with panurethral stricture treated by placing two BMGs, one as a ventral onlay in the proximal bulbar urethra and the other as a dorsal onlay in the distal bulbar and penile urethra. Success was defined as asymptomatic state with or without need for a postoperative single intervention such as dilatation or internal urethrotomy.

Results

The 38 patients had a mean age of 44 years, with lichen sclerosus as the predominant cause of stricture. The ultimate success rate was 84.2% at the end of 3 months and 89.5% at the end of 1 year. Recurrent strictures appeared only in the failed cases during the follow-up period of 11 months. None of the patients needed redo urethroplasty during the follow-up period.

Conclusions

A proximal ventral and distal dorsal onlay technique of BMG urethroplasty is an available alternative for repairing panurethral stricture. The technique described is simple and easily reproducible with encouraging results compared to other similar techniques.

Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife

PURPOSE

To compare efficacy and safety of visual internal urethrotomy (VIU) using holmium laser (Ho:YAG) (group A) versus cold knife (group B) in children with urethral strictures. It may be the first comparative study on this issue in children.

METHODS

This study compared Ho:YAG group, which was evaluated prospectively from January 2014 till January 2016, versus cold knife group, which was a historical control performed from March 2008 till February 2010. Children ≤ 13 years old with urethral strictures ≤ 1.5 cm were included successively. Recurrent cases, congenital obstructions and cases with complete arrest of dye in voiding cystourethrography were excluded. Scar tissue was incised at twelve o'clock. Outcome was compared using Student's t, Mann-Whitney, Chi-square or Fisher exact tests as appropriate.

RESULTS

Each group included 21 patients. Mean age was 6.27 ± 3.23 (2-13) years old. Mean stricture length was 1.02 versus 1 cm in group A versus B, respectively (p = 0.862). Ten cases of penile/bulbous strictures and another 11 cases of membranous strictures were found in each group. There was no significant difference between both groups in preoperative data. Success rate for initial VIU was 66.7% in group A versus 38% in group B (p = 0.064). This was associated with significantly higher Q_max in group A (mean 16.52 vs 12.09 ml/s; p = 0.03). Success rate after two trials of VIU was 76.2% for group A and 47.61% for group B (p = 0.057). No complications were reported in both groups.

CONCLUSION

Laser VIU has a higher success rate than cold knife VIU for urethral strictures ≤ 1.5 cm in children with significantly higher Q_max. Both are easy to perform, low invasive and safe.

Predictors for recurrence after urethroplasty in pediatric and adolescent stricture urethra

OBJECTIVE

This study aims at evaluating factors predicting recurrence of urethral stricture following urethroplasty in pediatric patients at a tertiary care center.

PATIENTS AND METHODS

Fifty-two patients of up to 18 years of age, who underwent urethroplasty, were reviewed. Duration of symptoms, etiology, previous intervention, and site of stricture, surgical modality, stricture length, and spongiofibrosis at stricture site, recurrence, and ancillary procedures required were recorded.

RESULTS

Forty-two (82.76%) patients (Group I) had recurrence-free course on follow-up. Of the 10 patients with recurrence (Group II), 9 had PTS and 1 had IS (p = 0.04). Most of the factors evaluated did not differ statistically between the groups; however, length of stricture (1.8 vs. 4.3 cm, p < 0.001) and degree of spongiofibrosis (61% vs. 90%, p = 0.003) were significantly different. Seven patients with recurrence were managed with single procedures, but three required multiple procedures because of multiple recurrences. History of incision and drainage for paraurethral abscess was significantly higher (28.6% vs. 100%, p = 0.002) in patients who had multiple recurrences.

CONCLUSIONS

Etiology, fibrosis at local site, and stricture length have significant impact on recurrence of pediatric urethral stricture disease. Associated paraurethral abscess may further compromise the outcome of urethroplasty.

Initial experience with lingual mucosal graft urethroplasty for anterior urethral strictures

BACKGROUND

To present the feasibility of lingual mucosal graft urethroplasty in anterior urethral strictures and appraisal of donor site morbidity.

METHODS

From November 2007 to December 2010, 14 patients underwent dorsal onlay lingual mucosal graft urethroplasty for anterior urethral strictures. Lingual mucosal graft was harvested from the lateral and undersurface of the tongue. Check micturating cystourethrograms were done 2 weeks after catheter removal and uroflowmetry after 3 months. Success was defined as normal uroflowmetry rates at 3 months in the absence of any postoperative instrumentation. Tongue was assessed for any residual pain, taste disturbances or restricted movement at 3 months.

RESULTS

Four patients had submucosal fibrosis of the oral cavity and their buccal mucosa was unfit for grafting. Mean (range) stricture length was 5 (3-16) cm and the operation time 170 (140-210) min. Graft width averaged 1.6 cm. Average length of harvested graft was 6.5 cm. Mean duration of follow-up was 12.8 months. Two patients developed stricture at the proximal anastomotic site. There were no donor site complications.

CONCLUSIONS

Lingual mucosal graft harvesting is simple, gives graft lengths comparable to buccal mucosa and is associated with negligible donor site morbidity.

Outcome of urethral strictures managed by general surgeons in a rural setting of India

In resource limited settings victims of urethral strictures often seek healthcare,when the strictures are far advanced. For a surgeon, management is indeed a challenging task, given the severity and extent of disease, lack of expertise, enough skills and equipment in the healthcare facility. This study was conducted at a rural teaching hospital in central India. All patients were assessed for the extent and severity of strictures and to rule out other causes of lower urinary obstruction. Outcome of all patients was assessed with American Urological Association Urinary Symptom Score and Urinary Flow Rate (ml/sec) before procedure, post procedure and at 6-12 months. Between 2007 and 2009, 110 patients, between 18-75 years of age were enrolled in this study which showed that a third of patients treated with urethral dilatation and optical internal urethrotomy required another intervention. It is conclude that urethral dilatation and internal optical dilatation result in short term improvement in urine flow rates and symptoms. Urethroplasty, the current gold standard of therapy for urethral strictures, results in outcomes that are clinically meaningful and more cost effective for a patient. The Americal Urological Association (AUA) symptom score and Urinarry Flow Ratemay be used to objectively assess outcome following surgical management of urethral strictures.

Outcome of Dorsal Onlay Buccal Mucosa Substitution Urethroplasty in Long Strictures of Anterior Urethra

BACKGROUND

The surgical treatment of adult anterior urethral strictures is constantly evolving. Controversy exists over the best means of reconstructing the anterior urethra.

METHODS

Twelve patients underwent buccal mucosal urethroplasty for long segment anterior urethral stricture between 2003 and 2005 . Eleven patients with a salvageable urethral plate were treated with one stage dorsal onlay urethroplasty, using a perineal or circumcoronal incision. One patient with a severely scarred urethral plate underwent two-stage urethroplasty.

RESULTS

At a mean follow up of 14.2 months (range 2 to 26) one (8.3%) patient had short recurrent stricture, which was treated with optical urethrotomy. The mean maximal urine flow rate improved from 8.3 ml/sec to 18.1 ml/sec after the surgery. There were no donor site complications. All patients had a normal slit like meatus and none had chordee or erectile dysfunction.

CONCLUSION

In long stricture of anterior urethra, dorsal onlay buccal mucosa urethroplasty provides excellent intermediate term results with a normal, wide caliber urethra.