1
|
Zhou S, Zhang J, Zhang J, Xiao X, Su Z, Liu M, Huang Z, Tian D, Liang W, Zhang J. Impact of Two Urethral Stent Types on Complications after One-Stage Hypospadias Repair Using the Duckett Procedure. Plast Reconstr Surg 2024; 153:1123-1131. [PMID: 37254244 DOI: 10.1097/prs.0000000000010783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The authors evaluated whether the new nickel-titanium alloy stent (NTAS) is superior to the traditional silicone stent used in hypospadias repair surgery in preventing complications such as urinary fistula. METHODS This retrospective cohort study included 576 patients with hypospadias who underwent NTAS or traditional silicone stent placement after hypospadias surgery between March of 2002 and August of 2019. The primary outcome was the rate of urinary fistula occurrence at 4 weeks (stent removal time), and the secondary outcomes were the rate of other complications, such as urethral stricture, urethral diverticulum, infection, and so on. The occurrence of complications in both groups was compared, and the important contributing factors of urinary fistula and urethral stricture were determined. RESULTS Among 576 patients, 398 were assigned to the NTAS group, and 178 were assigned to the silicone group. Thirty-five patients in the NTAS group and 30 in the silicone group developed urinary fistula, with a rate of 8.8% and 16.9%, respectively ( P = 0.005). Subgroup analysis showed that the differences were mainly in preschool patients (6 years or younger) ( P = 0.004) and those with the penile type of hypospadias ( P = 0.008). In addition, urethral stricture complicated five patients in the NTAS group and two in the silicone group, with a rate of 1.3% and 1.1%, respectively ( P = 1.000). Logistic regression showed that hypospadias type ( P = 0.001) and stent type ( P = 0.001) are the important risk factors for urethral fistula. CONCLUSION The NTAS reduced the occurrence of urinary fistula complications after hypospadias repair in preschool patients, and can be presented as a better choice for hypospadias surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Shiying Zhou
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Jian Zhang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Jiaqi Zhang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Xiaolian Xiao
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Zheng Su
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Meng Liu
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Zhaolun Huang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Dongjun Tian
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Weiqiang Liang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| | - Jinming Zhang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
| |
Collapse
|
2
|
Alzubaidi AN, Mawhorter M, Clark JY. Editorial Comment on "Refining Bacteriuria as a Risk Factor for Complications After Urethroplasty: Identifying the Culprit". Urology 2024; 186:7. [PMID: 38395081 DOI: 10.1016/j.urology.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Ahmad N Alzubaidi
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Michael Mawhorter
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Joseph Y Clark
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
| |
Collapse
|
3
|
Sun HH, Gupta S. Editorial Comment on "Outcomes of Ventral Onlay Buccal Mucosal Graft Urethroplasty in Bulbomembranous Urethral Strictures Post-transurethral Resection of the Prostate". Urology 2024; 186:15-16. [PMID: 38369199 DOI: 10.1016/j.urology.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Helen H Sun
- Urology Institute, University Hospitals, Cleveland, OH
| | - Shubham Gupta
- Urology Institute, University Hospitals, Cleveland, OH.
| |
Collapse
|
4
|
Calvo CI, Rourke KF. Routine Imaging After Bulbar Urethral Reconstruction Does Not Impact Surgical Outcomes and May Not Be Necessary. Urology 2024; 186:41-47. [PMID: 38417467 DOI: 10.1016/j.urology.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/02/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To assess whether omitting routine post-operative imaging adversely impacts clinical outcomes after bulbar urethroplasty. Contrast imaging is commonly performed prior to catheter removal after urethroplasty but the clinical need for this is unclear. METHODS This was a matched, case-control analysis comparing patients undergoing routine voiding cystourethrogram (VCUG) prior to catheter removal after bulbar urethroplasty to patients without imaging. Patients were matched with respect to age, stricture etiology, length, and urethroplasty technique. Follow-up consisted of clinical assessment 3 weeks post-operatively for VCUG/catheter removal, cystoscopy at 3-4 months with clinical assessment annually. Outcome measures were 90-day complications (Clavien ≥2) and stricture recurrence (failure to pass a 16-Fr flexible cystoscope on follow-up). Chi-square and Kaplan-Meier analysis were conducted where appropriate. RESULTS Hundred patients undergoing bulbar urethroplasty with VCUG prior to catheter removal were compared to 100 matched case controls without imaging. Groups did not differ with respect to failed endoscopic treatment (P = .82), prior urethroplasty (P = .09), comorbidities (P = .54), smoking (P = .42), or pre-operative bacteriuria (P = 1.00). The incidence of extravasation in the VCUG group was 2%. Overall 90-day complications were 9.5% and 15 patients developed recurrence with a median follow-up of 174 months. On chi-square analysis, 90-day complications did not differ between patients undergoing VCUG and those without (12% vs 7.0%; P = .34). On log-rank analysis, stricture recurrence did not differ between groups (P = .44). CONCLUSION Routine imaging with VCUG after bulbar urethroplasty does not influence the risk of post-operative complications or stricture recurrence. Surgeons should consider avoiding this potentially unnecessary examination in routine clinical practice.
Collapse
Affiliation(s)
- Carlos I Calvo
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
5
|
Wu Z, Chen M, Mori R. Urethral carcinoma after skin substitution urethral reconstruction. Can J Urol 2024; 31:11858-11860. [PMID: 38642465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Abstract
Urethral cancer after urethral reconstruction is an under-recognized, uncommon disease associated with significant morbidity and mortality. The survival rates of patients with carcinoma of the bulbar urethra are as low as 20%-30%. Stricture recurrence and unrecognized malignant changes present prior to reconstruction are major risk factors for urethral cancer. Skin substitution urethroplasty is subjected to higher rates of recurrence, which lends to the potential for carcinogenesis. We present a case of a 59-year-old male who underwent multi-stage skin substitution urethroplasty who developed urethral carcinoma 20 years later.
Collapse
Affiliation(s)
- Zhan Wu
- Division of Urology, Geisinger, Danville, Pennsylvania, USA
| | - Mystie Chen
- Division of Urology, Geisinger, Danville, Pennsylvania, USA
| | - Ryan Mori
- Division of Urology, Geisinger, Danville, Pennsylvania, USA
| |
Collapse
|
6
|
Qin N, Romine JF, Visser J. Placement of an artificial urethral sphincter for treatment of passive urinary incontinence after inadvertent prostatectomy and balloon dilation treatment for stricture formation in a 5-month-old dog. J Am Vet Med Assoc 2024; 262:1-5. [PMID: 38295515 DOI: 10.2460/javma.23.11.0634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Describe the management of incontinence with several therapies, culminating with the apparently successful treatment utilizing artificial sphincter placement following an inadvertent prostatectomy. ANIMAL 5-month-old 7.5-kg male neutered Miniature Schnauzer. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The patient was referred for dysuria and persistent stranguria following an iatrogenic total prostatectomy and urethrectomy. An extra pelvic urethral anastomosis was performed, followed by hospitalization for 2 weeks with a urinary catheter. The patient was further investigated for persistent stranguria, and a contrast urethrogram revealed a urethral stricture at the anastomosis site, which was treated with fluoroscopic balloon dilation. The stranguria resolved, but an acute nocturnal grade 3 passive urinary incontinence occurred, which was nonresponsive to medical management of phenylpropanolamine hydrochloride and estriol. An artificial urethral sphincter was placed, leading to continence after 5 top-ups to a total volume of 0.9 mL. The patient remained continent for 5.5 weeks before abrupt incontinence recurred, which was resolved by another 0.1-mL top-up. No further signs of incontinence occurred in the 11 months following. TREATMENT AND OUTCOME The placement of an artificial urethral sphincter successfully managed urinary incontinence in this patient. Continence was achieved with no significant complications other than a transient loss of continence. Long-term follow-up 14 months after sphincter placement revealed that the patient had remained continent since the final sphincter top-up. The owner reported a significant improvement in the patient's quality of life following successful incontinence management. CLINICAL RELEVANCE This case highlighted the benefits of placing an artificial urethral sphincter in managing urinary incontinence after select cases of prostatectomy in dogs that are unresponsive to medical management.
Collapse
Affiliation(s)
- Nancy Qin
- 1Department of Surgery, Animal Referral Centre, Auckland, New Zealand
| | - Jessica F Romine
- 2Department of Medicine, Animal Referral Centre, Auckland, New Zealand
| | - Judith Visser
- 1Department of Surgery, Animal Referral Centre, Auckland, New Zealand
| |
Collapse
|
7
|
Mousa A, Eissa A, Rawal AY, Zoeir A. Outcomes of Ventral Onlay Buccal Mucosal Graft Urethroplasty in Bulbomembranous Urethral Strictures Post-transurethral Resection of the Prostate. Urology 2024; 186:9-14. [PMID: 38403138 DOI: 10.1016/j.urology.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate the outcomes of ventral onlay buccal mucosal graft urethroplasty (VOBMGU) in bulbomembranous urethral strictures after transurethral resection of the prostate. METHODS After approval of the institutional ethical committee, we retrospectively examined the database of patients diagnosed with post-TURP urethral stricture (PTS) and treated by VOBMGU from January 2020 to January 2022. The patients were evaluated by retrograde urethrogram and voiding cystourethrogram. Follow-up evaluation included assessment of lower urinary tract symptoms, physical examination, uroflowmetry (Q-max and International Prostate Symptom Score) 3, 6, and 12months of follow-up. RESULTS A total of 30 patients underwent VOBMGU for bulbomembranous PTS were included. The median age of the patients was 63.5 (11.25). The median stricture length was 3.5 (1.5) cm. During follow-up, the mean Q-max significantly increased to 21.1 ± 5.5 mL/s (P < .0001), 20.1 ± 5.4 mL/s (P < .001), and 19.1 ± 5.3 mL/s (P < .003) at 3, 6, and 12months, respectively. IPSS significantly decreased to 8.93 ± 6.37 at the 12-month follow-up mark (P < .0001). Three patients developed stricture recurrence and two patients developed postoperative urinary incontinence. CONCLUSION VOBMGU in cases of bulbomembranous urethral PTS offered excellent functional outcomes with low stricture recurrence and minimal risk of incontinence. Further prospective studies are warranted to confirm the results.
Collapse
Affiliation(s)
- Ayman Mousa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amar Y Rawal
- Department of Urology, Heartland Regional Hospital, Marion, IL
| | - Ahmed Zoeir
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt.
| |
Collapse
|
8
|
Chang KT, Lai PH, Lu IC, Huang RY, Lin CW, Huang CH. Urinary catheter placement and adverse urinary outcomes with a focus on elevated risk in men with indwelling Foley catheters. J Am Geriatr Soc 2024; 72:1166-1176. [PMID: 38401032 DOI: 10.1111/jgs.18819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Prior studies indicated a link between urinary catheter use and urinary complications, highlighting the need for comprehensive, gender-specific investigations. This study explored the association through a national retrospective cohort, emphasizing gender disparities and long-term outcomes. METHODS Our study utilized data from the entire population covered by Taiwan's National Health Insurance Research Database from 2000 to 2017. We included 148,304 patients who had undergone Foley catheter placement and their propensity-scores matched controls in the study. We evaluated urinary complications, which encompassed urinary tract cancer, urolithiasis, urethral stricture, obstructive uropathy, reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, urinary tract rupture, and urinary tract infection. These were assessed using the Fine and Gray sub-distribution proportional hazards model to compare between the Foley and non-Foley groups. Sensitivity analyses were conducted with different matching ratios. RESULTS In the study, the non-Foley group presented a marginally higher mean age (75.24 ± 10.47 years) than the Foley group (74.09 ± 10.47 years). The mean duration of Foley catheterization was 6.1 ± 4.19 years. Men with Foley catheterization exhibited the highest adjusted sub-distribution hazard ratios for urinary tract cancer (6.57, 95% CI: 5.85-7.37), followed by women with Foley catheterization (4.48, 95% CI: 3.98-5.05), and men without catheterization (1.58, 95% CI: 1.39-1.8) in comparison with women without the procedure. Furthermore, men with Foley catheterization were found to be at the greatest risk for complications such as urolithiasis, urethral stricture, obstructive and reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, and urinary tract rupture. Conversely, women with urinary catheterization were most susceptible to urinary tract infections. CONCLUSIONS The evidence confirms that urinary catheterization significantly increases urinary complications, particularly among men. Our study underscores the crucial need for healthcare providers to carefully evaluate the necessity of catheterization, aim to shorten its duration whenever feasible, and strictly adhere to established protocols to minimize complications.
Collapse
Affiliation(s)
- Kai-Ting Chang
- Department of Family Medicine, E-Da Dachang hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Po-Husan Lai
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - I-Cheng Lu
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Department of Occupational Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
| | - Ru-Yi Huang
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
- Department of Holistic Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Chi-Wei Lin
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Chi-Hsien Huang
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| |
Collapse
|
9
|
Sterling J, Simhan J, Flynn BJ, Rusilko P, França WA, Ramirez EA, Angulo JC, Martins FE, Patel HV, Higgins M, Swerdloff D, Nikolavsky D. Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients With Postprostatectomy, Postradiation Anastomotic Stenosis. J Urol 2024; 211:596-604. [PMID: 38275201 DOI: 10.1097/ju.0000000000003848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE The treatment of urethral stenosis after a combination of prostatectomy and radiation therapy for prostate cancer is understudied. We evaluate the clinical and patient-related outcomes after dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) in men who underwent prostatectomy and radiation therapy. MATERIALS AND METHODS A multi-institutional, retrospective review of men with vesicourethral anastomotic stenosis or bulbomembranous urethral stricture disease after radical prostatectomy and radiation therapy from 8 institutions between 2013 to 2021 was performed. The primary outcomes were stenosis recurrence and development of de novo stress urinary incontinence. Secondary outcomes were surgical complications, changes in voiding, and patient-reported satisfaction. RESULTS Forty-five men were treated with D-BMGU for stenosis following prostatectomy and radiation. There was a total of 7 recurrences. Median follow-up in patients without recurrence was 21 months (IQR 12-24). There were no incidents of de novo incontinence, 28 patients were incontinent pre- and postoperatively, and of the 6 patients managed with suprapubic catheter preoperatively, 4 were continent after repair. Following repair, men had significant improvement in postvoid residual, uroflow, International Prostate Symptom Score, and International Prostate Symptom Score quality-of-life domain. Overall satisfaction was +2 or better in 86.6% of men on the Global Response Assessment. CONCLUSIONS D-BMGU is a safe, feasible, and effective technique in patients with urethral stenosis after a combination of prostatectomy and radiation therapy. Although our findings suggest this technique may result in lower rates of de novo urinary incontinence compared to conventional urethral transection and excision techniques, head-to-head comparisons are needed.
Collapse
Affiliation(s)
- Joshua Sterling
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
| | - Jay Simhan
- Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Brian J Flynn
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul Rusilko
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wagner A França
- Department of Urology, Hospital do Servidor Público Estadual de São Paulo, Sao Paulo, Brazil
| | | | - Javier C Angulo
- Department of Medical Clinic, Universidad Europea de Madrid, Madrid, Spain
| | - Francisco E Martins
- Department of Urology, University of Lisbon, Hospital of Santa Maria, Lisbon, Portugal
| | - Hiren V Patel
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Margaret Higgins
- Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Swerdloff
- Department of Urology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Dmitriy Nikolavsky
- Department of Urology, SUNY Upstate Medical University, Syracuse, New York
| |
Collapse
|
10
|
Viegas V, Freton L, Richard C, Haudebert C, Khene ZE, Hascoet J, Verhoest G, Mathieu R, Vesval Q, Zhao LC, Bensalah K, Peyronnet B. Robotic YV plasty outcomes for bladder neck contracture vs. vesico-urethral anastomotic stricture. World J Urol 2024; 42:172. [PMID: 38506927 DOI: 10.1007/s00345-024-04814-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/16/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To compare the outcomes of patients undergoing robotic YV plasty for bladder neck contracture (BNC) vs. vesico-urethral anastomotic stricture (VUAS). METHODS A retrospective study included male patients who underwent robotic YV plasty for BNC after endoscopic treatment of BPH or VUAS between August 2019 and March 2023 at a single academic center. The primary assessed was the patency rate at 1 month post-YV plasty and during the last follow-up visit. RESULTS A total of 21 patients were analyzed, comprising 6 in the VUAS group and 15 in the BNC group. Patients with VUAS had significantly longer operative times (277.5 vs. 146.7 min; p = 0.008) and hospital stay (3.2 vs. 1.7 days; p = 0.03). Postoperative complications were more common in the VUAS group (66.7% vs. 26.7%; p = 0.14). All patients resumed spontaneous voiding postoperatively. Five patients (23.8%) who developed de novo stress urinary incontinence had already an AUS (n = 1) or required concomitant AUS implantation (n = 3), all of whom were in the VUAS group (83.3% vs. 0%; p < 0.0001). The proportion of patients improved was similar in both groups (PGII = 1 or 2: 83.3% vs. 80%; p = 0.31). Stricture recurrence occurred in 9.5% of patients in the whole cohort, with no significant difference between the groups (p = 0.50). Long-term reoperation was required in three VUAS patients, showing a statistically significant difference between the groups (p = 0.05). CONCLUSION Robotic YV plasty is feasible for both VUAS and BNC. While functional outcomes and stricture-free survival may be similar for both conditions, the perioperative outcomes were less favorable for VUAS patients.
Collapse
Affiliation(s)
- Vanessa Viegas
- Department of Urology, Hospital Universitario de La Princesa, Madrid, Spain.
| | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | | | | | | | | | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Quentin Vesval
- Department of Urology, University of Rennes, Rennes, France
| | - Lee C Zhao
- Department of Urology, New York University, New York, USA
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | |
Collapse
|
11
|
Wu Z, Tang Z, Zheng Z, Tan S. A novel trauma induced urethral stricture in rat model. Sci Rep 2024; 14:6325. [PMID: 38491041 PMCID: PMC10943079 DOI: 10.1038/s41598-024-55408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024] Open
Abstract
Urethral stricture (US) is a longstanding disease, while there has not existed a suitable animal model to mimic the condition. We aimed to establish a trauma-induced US animal model to simulate this clinical scenario. A total of 30 rats were equally distributed into two groups, sham and US group. All rats were anesthetized with isoflurane and undergone cystostomy. In the US group, a 2 mm incision was made in the urethra and sutured to induce US. The sham group only make a skin incision on the ventral side of the anterior urethra. 4 weeks later, ultrasound and cystourethrography were performed to evaluate the degree of urethral stricture, pathological examinations were carried out to evaluate the degree of fibrosis. Urodynamic evaluation and mechanical tissue testing were performed to evaluate the bladder function and urethral tissue stiffness. The results showed that the urethral mucosa was disrupted and urethral lumen was stenosed in the US group. Additionally, the US group showed elevated bladder pressure, prolonged micturition intervals and increased tissue stiffness. In conclusion, the rat urethral stricture model induced by trauma provides a closer representation of the real clinical scenario. This model will significantly contribute to advancing research on the mechanisms underlying traumatic urethral stricture.
Collapse
Affiliation(s)
- Ziqiang Wu
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China
| | - Zhengyan Tang
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China
| | - Zhihuan Zheng
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China.
| | - Shuo Tan
- Department of Urology, Third Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China.
| |
Collapse
|
12
|
Katibov M I, Bogdanov A B, Veliev E I, Laurent O B. [Non-transecting anastomotic urethroplasty for strictures of the bulbar urethra. Systematic review]. Urologiia 2024:135-142. [PMID: 38650419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The results of using non-transecting anastomotic urethroplasty in men with bulbous urethral strictures are presented in the review. A total of 25 original publications were found, including 20 foreign and 5 Russian articles. The studies included from 1 to 358 patients who underwent anastomotic urethroplasty without transection of the corpus spongiosum (average number of patients in a study was 54). Etiological factors were indicated in 17 articles. Most studies (10 out of 17) indicated idiopathic etiology as the predominant one. There was no correlation between the results of the procedure and the etiology of urethral stricture. The mean length of urethral stricture in the vast majority of studies was less than 2 cm, and only in a few studies it was larger, with a maximum mean value of 3.9 cm. Postoperative complication rates were reported in 20 studies and ranged from 0% to 23.9% within one study (median 8.4%). In general, mild complications occurred, corresponding to category I-II according to the Clavien-Dindo classification. The incidence of erectile dysfunction was evaluated in 18 studies and ranged from 0% to 23% (average value of 6.5%). The success of non-transecting anastomotic urethroplasty averaged 94.7% (82-100%) with a median postoperative follow-up of 24.5 months (3-150 months). In 9 out of 25 studies, an additional comparison with transecting technique was done. In 6 studies, the superiority of the non-transecting technique in terms of treatment success and preservation of sexual function was found. The obtained results showed the high efficiency and safety of non-transecting anastomotic urethroplasty in case of short strictures of the bulbous urethra.
Collapse
Affiliation(s)
- I Katibov M
- GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - B Bogdanov A
- GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - I Veliev E
- GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - B Laurent O
- GBU of the Republic of Dagestan City Clinical Hospital, Makhachkala, Russia
- S.P. Botkins State Clinical Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| |
Collapse
|
13
|
Zhang X, Wang W, Zhang H, Zhang L, Yang C, Zhang H. Lower partial pubicectomy for postoperative complicated posterior urethral stricture. Int Urol Nephrol 2024; 56:1109-1115. [PMID: 37642798 PMCID: PMC10853320 DOI: 10.1007/s11255-023-03746-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To report the experience of partial inferior pubicectomy in the treatment of complex posterior urethral stricture after trauma. METHODS A total of 46 patients with post-traumatic posterior urethral stricture admitted to the Department of Urology of our Hospital from January 2013 to September 2021 were selected as the research objects and underwent urethroplasty (including nine patients who had failed previous perineal repair surgery and adopted partial inferior pubicectomy approach). Retrograde urethrograph (RUG) and urine flow measurement were performed at 1, 3, 12 and 18 months after operation, and follow-up was performed when necessary. The clinical data during treatment were statistically analyzed. RESULTS All 46 patients underwent urethroplasty successfully, of which nine were treated with partial pubicectomy, accounting for 19.57% of the total. The causes of the disease were motor vehicle accident in 4 cases, falling collision injury in 2 cases, and rolling injury of military exercise tank in 3 cases. Among the 9 patients, 2 were children (22.22%), aged 8 and 12 years, and 7 were adults (77.78%), aged 19-44 (28.42 ± 1.56) years. Among the 9 patients, 6 had erectile dysfunction, accounting for 66.67%. The length of posterior urinary tract stenosis was (5.12 ± 0.57) cm. The operation time was (290.34 ± 12.35) min from anesthesia induction to skin closure. Five patients received 2 U blood transfusion during operation and three patients received 3 U blood transfusion after operation. The average hospital stay was 12-16 (14.24 ± 1.25) days, and the follow-up was 12-24 (18.24 ± 1.35) months. After surgery, one patient developed HIP abscess, which was successfully treated conservatively. One patient had dysuria 1 month after operation and was successfully treated by transurethral dilatation. One case had postoperative infection and recovered after intravenous administration of potent antibiotics. Cystourethrography was performed 3 months after operation, and there was no difference between patients with wide, long or short anastomotic stretch defects. All patients met the criteria for surgical success. CONCLUSION Partial inferior pubicectomy is a good surgical procedure for the repair of complicated posterior urethral stricture after operation. It is safe and reliable, can better display the prostatic apex and surgical field, shorten the length of reconstructed urethra, and has good postoperative effect. It has no direct or long-term effect on the stability of pelvis or bladder. However, further studies in a larger cohort of patients with complex posterior urethral strictures after repair are needed to demonstrate the specific indications for partial pubicectomy.
Collapse
Affiliation(s)
- Xiaoming Zhang
- Department of Urology, General Hospital of Southern Theatre Command, Pepole's Liberation Army, Guangzhou, 510010, China.
| | - Wei Wang
- Department of Urology, General Hospital of Southern Theatre Command, Pepole's Liberation Army, Guangzhou, 510010, China
| | - Haiyan Zhang
- Medical Security Centre, General Hospital of Southern Theatre Command, Pepole's Liberation Army, Guangzhou, 510010, China
| | - Lei Zhang
- Department of Urology, General Hospital of Southern Theatre Command, Pepole's Liberation Army, Guangzhou, 510010, China
| | - Chenglin Yang
- Department of Urology, General Hospital of Southern Theatre Command, Pepole's Liberation Army, Guangzhou, 510010, China
| | - Hui Zhang
- Department of Urology, General Hospital of Southern Theatre Command, Pepole's Liberation Army, Guangzhou, 510010, China
| |
Collapse
|
14
|
Eichenberger EM, Donzo MW, Anderson R, Karadkhele G, Pouch SM, Larsen CP. Risk factors and outcomes of bloodstream infection from a urinary source in kidney transplant recipients. Clin Transplant 2024; 38:e15279. [PMID: 38485657 DOI: 10.1111/ctr.15279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Bacteriuria is common among kidney transplant recipients (KTR). Risk factors and outcomes associated with bloodstream infection due to a urinary source (BSIU) in KTR are poorly understood. METHODS This single center case-control study from 2010 to 2022 compared KTR with BSIU to those with bacteria without bloodstream infection (BU). Multivariable logistic regression identified BSIU risk factors, and Cox models assessed its impact on graft failure. RESULTS Among 3435 patients, who underwent kidney transplantation at Emory Hospital, 757 (22%) developed bacteriuria, among whom 142 (18.8%) were BSIU. Male sex, presence of Escherichia coli, Klebsiella pneumoniae, or Pseudomonas species in urine culture, urethral stricture, neuromuscular bladder disorder, and history of diabetes-induced renal failure were independently associated with increased odds of BSIU (Male sex: aOR 2.29, 95% CI 1.52, 3.47, E. coli: aOR 5.14, 95% CI 3.02, 9.13; K. pneumoniae aOR 3.19, 95% CI 1.65, 6.27, Pseudomonas spp aOR 3.06, 95% CI 1.25, 7.18; urethral stricture: 4.10, 95% CI 1.63, 10.3, neuromuscular bladder disorder aOR 1.98, 95% CI 1.09, 3.53, diabetes: aOR 1.64, 95% CI 1.08, 2.49). BSIU was associated with increased hazard of graft failure (HR 1.52, 95% CI 1.05, 2.20). CONCLUSION Close monitoring is warranted for male KTR with bacteriuria, those with urine cultures positive for Pseudomonas spp, K. pneumoniae, or E. coli, as well as KTR with a history of diabetes-induced renal failure, urethral stricture, or neuromuscular bladder disorder due to their risk for developing BSIU. Future research should explore strategies to mitigate BSIU risk in these high-risk KTR and reduce the associated risk of long-term graft failure.
Collapse
Affiliation(s)
- Emily M Eichenberger
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Geeta Karadkhele
- Emory Transplant Center, Emory University Hospital, Atlanta, Georgia, USA
| | - Stephanie M Pouch
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christian P Larsen
- Emory Transplant Center, Emory University Hospital, Atlanta, Georgia, USA
- Department of Surgery, Emory University Hospital, Atlanta, Georgia, USA
| |
Collapse
|
15
|
Uğur R, Şimşek A. The best method for erection function in urethroplasty; is excision and primary anastomosis or buccal mucosal graft urethroplasty? Actas Urol Esp 2024; 48:170-176. [PMID: 37981167 DOI: 10.1016/j.acuroe.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION The aim of this study is to evaluate and compare erection function (EF) after Excision and Primary Anastomosis Urethroplasty (EPAU) and Buccal Mucosal Graft Urethroplasty (BMGU) in bulbar urethral stricture. METHODS Patients who underwent urethroplasty were identified retrospectively. The criteria for inclusion in the study were determined as being over 18 years old and under 70 years old, being sexually active. Exclusion criteria are; preoperative severe erectile dysfunction, stricture outside the bulbar urethra, psychosocial incompatibility, urethral stricture related to pelvic fracture, follow-up time less than a year. As the primary endpoint, the International Index of Erectile Function-5 (IIEF-5) was determined as a comparison of EF in the preoperative and third, sixth and twelfth months after surgery. The secondary endpoint was the evaluation of the effects of demographic data, stricture and treatment characteristics on EF. RESULTS Fifty patients were identified considering the inclusion/exclusion criteria. It was observed that there were 30 patients who underwent EPAU and 20 patients who underwent BMGU. At the third month after surgery, EF showed a statistically significant decrease in the EPAU group. In both patient groups, it was observed that the early negative effects after the operation in EF started to improve in the sixth month and returned to the baseline level by the first year. CONCLUSION EPAU and BMGU techniques have a similar effect on EF in the medium and long term. Both methods can be used safely and effectively in the appropriate patient group.
Collapse
Affiliation(s)
- R Uğur
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey.
| | - A Şimşek
- Servicio de Urología, Hospital Urbano de Basaksehir Cam y Sakura, Estambul, Turkey
| |
Collapse
|
16
|
Guo H, Dai Z, Zhong L, Jiang Y, Lu Y, Liang T. Development of a Nomogram Model to Predict the Risk of Stricture Recurrence after Urethroplasty: A Retrospective Study. ARCH ESP UROL 2024; 77:202-209. [PMID: 38583013 DOI: 10.56434/j.arch.esp.urol.20247702.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
OBJECTIVE A retrospective study was performed to analyse the influencing factors of stricture recurrence after urethroplasty and to establish a predictive nomogram model. METHODS The clinical data of patients who underwent urethroplasty in our hospital from January 2021 to June 2023 were retrospectively analysed. Depending on whether stenosis occurs six months after surgery, the patients were divided into recurrence and nonrecurrence groups. Logistic regression analysis was performed on the indicators with statistically significant differences between the two groups in single factor analysis to analyse the influencing factors of postoperative recurrence risk of stricture. X64.4.1.3 version R language and external source packages were used to build the nomogram model. The nomogram was internally validated through 10-fold cross-validation, and C-index was calculated. The area under the curve (AUC) of the receiver operating characteristic curve was employed to evaluate the results of the internal validation. RESULTS Amongst 105 patients who underwent urethroplasty in our hospital, 15 patients with recurrence were included in the recurrence group, and 90 patients without recurrence were included in the nonrecurrence group. The length of stricture segment, history of urethroplasty and smoking history within 3 months before surgery were risk factors for stricture recurrence, with odds ratio (OR) values of 1.874 (95% CI: 1.103-5.725), 1.670 (95% CI: 1.105-2.904) and 1.740 (95% CI: 1.456-5.785), respectively. The constructed nomogram obtained an average AUC of 0.842 and an average C-index of 0.794, calculated after 200 times of 10-fold cross-validation. CONCLUSIONS From the data of this study, it can be deduced that the influencing factors of stricture recurrence after urethroplasty include the length of stricture segment, history of urethroplasty and smoking history of 3 months before surgery. Using the above factors as a basis to construct a predictive nomogram model is helpful to screen high-risk patients with recurrence of stricture after urethroplasty.
Collapse
Affiliation(s)
- Hang Guo
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 201306 Shanghai, China
| | - Zhenghao Dai
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 201306 Shanghai, China
| | - Lichang Zhong
- Department of Ultrasound in Medicine, Sixth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University, Shanghai Institute of Ultrasound in Medicine, 201306 Shanghai, China
| | - Yiwen Jiang
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, 201306 Shanghai, China
| | - Yuting Lu
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, 201306 Shanghai, China
| | - Tao Liang
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 201306 Shanghai, China
| |
Collapse
|
17
|
Wang M, Zhou L, Liao B, Ye D, Ma Y, Jian Z, Yuan C, Jin X, Li H, Wang K. Transperineal anastomotic posterior urethroplasty with bulbocavernosus flap and fibrin sealant in the complicated posterior urethral stricture reconstruction: a retrospective cohort study. Int J Surg 2024; 110:668-674. [PMID: 37983809 PMCID: PMC10871590 DOI: 10.1097/js9.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Management of complicated posterior urethral stricture is challenging. Modified transperineal anastomotic urethroplasty (TAU) with bulbocavernosus flap interposition and human fibrin sealant provides another treatment option. The authors aimed to evaluate whether this technique could improve the success rate in the complicated posterior urethral stricture reconstruction in this study. MATERIALS AND METHODS Between 2016 and 2019, 48 patients underwent either conventional or modified TAU. The criteria for success included both the absence of clinical symptoms and no need for further surgical intervention during follow-up. RESULTS Twelve patients underwent the modified TAU (group A) using bulbocavernosus flap interposition and human fibrin sealant. Thirty-six patients underwent the traditional end-to-end anastomotic urethroplasty (group B). Follow-up was 24.3-57.2 months. The patients in group A had a higher surgery success rate compared to the patients in group B (91.7 vs. 63.9%, P =0.067), with a quasi-significant result. Besides, no postoperative complications were observed in group A, while two individuals in group B had urinary incontinence, but the difference was not significant (0 vs. 5.6%, P =0.404). CONCLUSION Based on the preliminary results, modified TAU with bulbocavernosus flap interposition and human fibrin sealant is a safe and feasible technique for complicated posterior urethral stricture reconstruction.
Collapse
Affiliation(s)
- Menghua Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
| | - Banghua Liao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
| | - Donghui Ye
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
| | - Zhongyu Jian
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
- West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan
| | - Chi Yuan
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
| | - Xi Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
| | - Kunjie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital
| |
Collapse
|
18
|
Hu N, Zou Y, Deng X, Zhang L, Zhai Z, Yin R. Photodynamic therapy for male genital lichen sclerosus with urethral stricture-Case report. Photodiagnosis Photodyn Ther 2024; 45:103947. [PMID: 38154603 DOI: 10.1016/j.pdpdt.2023.103947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
Male genital lichen sclerosus (MGLSc) typically impacts the external genitalia, resulting in balanitis, erectile pain, urination symptoms, and/or urinary retention. Urethral stricture develops in up to 20 % of these patients, which is usually found in the distal part of the urethra but can, in severe instances, impact the entire urethra and cause structural changes. Patients with skin lesions limited to the foreskin and partially extending to the glans can typically be cured by circumcision, but the recurrence rate of stricture is high when the glans or urethra is extensively involved. In the following case report, we describe a 45-year-old man with a history of MGLSc for 3 years and urethral stricture for 2 years, and these conditions remained untreated after circumcision. We emphasize that treatment with 5-aminolevulinic acid-induced photodynamic therapy (ALA-PDT) may further improve outcomes in such severe cases.
Collapse
Affiliation(s)
- Nan Hu
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yongzhen Zou
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Xun Deng
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Lian Zhang
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Zhifang Zhai
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Rui Yin
- Department of Dermatology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
| |
Collapse
|
19
|
Isali I, Wong TR, Wu CHW, Scarberry K, Gupta S, Erickson BA, Breyer BN. Genomic Risk Factors for Urethral Stricture: A Systematic Review and Gene Network Analysis. Urology 2024; 184:251-258. [PMID: 38160764 DOI: 10.1016/j.urology.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To identify genes that may play a role in urethral stricture and summarize the results of studies that have documented variations in gene expression among individuals with urethral stricture compared to healthy individuals. METHODS A systematic search was conducted in Cochrane, Ovid, Web of Science, and PubMed, limiting the results to articles published between January 1, 2000 and January 30, 2023. Only studies comparing the difference in gene expression between individuals with urethral stricture and healthy individuals utilizing molecular techniques to measure gene expression in blood, urine, or tissue samples were included in this systematic review. Gene network and pathway analyses were performed using Cytoscape software, with input data obtained from our systematic review of differentially expressed genes in urethral stricture. RESULTS Four studies met our criteria for inclusion. The studies used molecular biology methods to quantify gene expression data from specimens. The analysis revealed gene expressions of CXCR3 and NOS2 were downregulated in urethral tissue samples, while TGFB1, UPK3A, and CTGF were upregulated in plasma, urine and urethral tissue samples, respectively, in patients with urethral stricture compared to healthy controls. The analysis demonstrated that the most significant pathways were associated with phosphoinositide 3-kinase (PI3 kinase) and transforming growth factor beta 1/suppressor of mothers against decapentaplegic (TGF-β1/SMAD) signaling pathways. CONCLUSION This systematic review identified gene expression variations in several candidate genes and identified underlying biological pathways associated with urethral stricture. These findings could inform further research and potentially shift treatment and prevention strategies for urethral stricture.
Collapse
Affiliation(s)
- Ilaha Isali
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Thomas R Wong
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Chen-Han Wilfred Wu
- Department of Urology, Case Western Reserve University, Cleveland, OH; Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH
| | - Kyle Scarberry
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | | | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
| |
Collapse
|
20
|
Kairambayev Y, Bulegenov T, Omarov N, Kuderbayev M, Syzdykbayev M, Glushkova N, Akhmetzhanova D, Kaskabayeva A, Muzdubayeva Z, Akimzhanov K, Pivina L. Prevention of Postoperative Urethral Strictures by Irrigation with 5-Fluorouracil via a Modified Urinary Catheter. Medicina (Kaunas) 2024; 60:102. [PMID: 38256363 PMCID: PMC10819259 DOI: 10.3390/medicina60010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/25/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Urethral strictures are the most common complications after surgical treatments of benign prostatic hyperplasia (BPH). Despite various preventive measures, the search for medications with antiproliferative activity and the development of surgical procedures to prevent the development of urethral strictures are still relevant. We evaluated the preventive efficacy of 5-fluorouracil against urethral strictures in patients undergoing surgery for BPH. Materials and Methods: A non-randomized clinical trial including 246 male patients with an average age of 70.0 ± 8.0 years was conducted. The main study group included 124 patients who, in addition to the standard treatment, received lavage with a 5-fluorouracil solution (1000 mg/20 mL per 500 mL of 0.9% isotonic saline) using a modified three-way urethral catheter. The monitoring of clinical, laboratory, and instrumental parameters was carried out 10 days, 3 months, and 6 months after surgery. Results: The evaluation of severity for dysuria symptoms in patients using the IPSS scale throughout the entire follow-up period showed a statistically significant decrease in ischuria and stranguria, prolongation of the interval between urinations, a decrease in intermittent urination, urinary incontinence, and straining before urination in the main group in comparison with the control patients. The patients of both study groups noted an improvement in the quality of life. It was found statistically significant decrease in the maximum urinary flow rate in the main group (p < 0.001). In the control group, after three months, four cases of urethral strictures and stenosis were recorded; after six months, this rate reached nine cases (7.3%), while in the main group, only one patient with infravesical obstruction was found (0.8%) (χ2 = 3.855, p < 0.05). Conclusions: The results of our study could indicate the effectiveness of the antiproliferative drug 5-fluorouracil in combination with use of a modified catheter in relation to the development of postoperative urethral strictures.
Collapse
Affiliation(s)
- Yerbol Kairambayev
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Tolkyn Bulegenov
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Nazarbek Omarov
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Muratkan Kuderbayev
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Marat Syzdykbayev
- Department of Anesthesiology and Reanimatology, Semey Medical University, Semey 071400, Kazakhstan;
| | - Natalya Glushkova
- Health Policy and Organization Department, Al-Farabi Kazakh National University, Almaty 050040, Kazakhstan;
| | | | - Alida Kaskabayeva
- Department of Internal Medicine, Semey Medical University, Semey 071400, Kazakhstan; (A.K.); (Z.M.)
| | - Zhanna Muzdubayeva
- Department of Internal Medicine, Semey Medical University, Semey 071400, Kazakhstan; (A.K.); (Z.M.)
| | - Kuat Akimzhanov
- Department of Surgery Disciplines, Semey Medical University, Semey 071400, Kazakhstan; (Y.K.); (T.B.); (N.O.); (M.K.); (K.A.)
| | - Lyudmila Pivina
- Department of Emergency Medicine, Semey Medical University, Semey 071400, Kazakhstan
| |
Collapse
|
21
|
Klein R, Vasan R, Guercio C, Rusilko P. Minimally Invasive Management of Posterior Urethral Stricture/Stenosis with DVIU and Mitomycin C Injection. Urology 2024; 183:e317-e319. [PMID: 37866650 DOI: 10.1016/j.urology.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE To demonstrate a technique for minimally invasive endoscopic management of posterior urethral strictures, including those at the bladder neck and vesicourethral anastomosis. METHODS Herein, we have included endoscopic video footage from 3 patients with posterior urethral strictures, including 1 at the bladder neck, 1 at the vesicourethral anastomosis, and 1 in the bulbomembranous urethra. In each patient, we perform a direct visualization internal urethrotomy (DVIU) with incisions at the 5 and 7 o'clock positions to widen the urethral lumen, followed by injection of 2 mg mitomycin C (MMC) in a total volume of 5 mL sterile water. RESULTS Herein, we describe our technique for the endoscopic management of posterior urethral strictures, including those in the prostatic urethra and bladder neck. MMC injection, in conjunction with traditional DVIU, adds minimally to the complexity and length of the procedure but may substantially improve long-term surgical outcomes. CONCLUSION Bladder outlet obstruction due to stenosis or stricture of the posterior urethra is a common urologic diagnosis whose etiology can often be traced to prior urethral manipulation or iatrogenic trauma. While Americal Urological Assicuation (AUA) guidelines state that dilation or direct visualization internal urethrotomy (DVIU) should be offered for bulbar strictures measuring less than 2 cm in length, recent evidence suggests that DVIU with or without MMC injection may have utility in the management of bladder neck or vesicourethral anastomotic contractures. We have found that DVIU with subsequent MMC injection is a viable minimally invasive approach for the treatment of posterior urethral strictures. While more data are needed to better understand the long-term success rates of these procedures, this approach should be considered for patients with a bladder outlet obstruction secondary to a short stricture of the posterior urethra, bladder neck, or vesicourethral anastomosis.
Collapse
Affiliation(s)
- Roger Klein
- UPMC Department of Urology, Pittsburgh, Pittsburgh.
| | - Robin Vasan
- UPMC Department of Urology, Pittsburgh, Pittsburgh.
| | | | - Paul Rusilko
- UPMC Department of Urology, Pittsburgh, Pittsburgh; UPMC Department of Plastic Surgery, Pittsburgh, Pittsburgh.
| |
Collapse
|
22
|
Trikoupi G, Papadopoulou P, Adamama-Moraitou K, Papazoglou L. Diagnosis of traumatic urethral stricture in a canine patient with contrast-enhanced voiding urosonography : A case report. Vet Radiol Ultrasound 2024; 65:10-13. [PMID: 38047483 DOI: 10.1111/vru.13315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
A 5-year-old intact male mixed-breed dog presented with a 3-day history of stranguria and dysuria. Results of physical examination, plain radiographs, and ultrasonography were consistent with a traumatic urethral stricture in the prescrotal urethra just under the previous trauma region, resulting in partial obstruction of urine outflow. Contrast-enhanced voiding urosonography (CE-VUS) was performed, and a urethral stricture was confirmed. The dog underwent surgery. A scrotal urethrostomy was performed. After 3 days of hospitalization, the dog was discharged from the Clinic. Based on an extensive literature review, this is the first report using CE-VUS to evaluate urethral pathology in a canine patient.
Collapse
Affiliation(s)
- Georgia Trikoupi
- Faculty of Health Sciences, Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paraskevi Papadopoulou
- Faculty of Health Sciences, Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Katerina Adamama-Moraitou
- Faculty of Health Sciences, Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lysimachos Papazoglou
- Faculty of Health Sciences, Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
23
|
Ayangbesan A, Koch GE, Dagostino C, Proctor JM, Gambrah H, Bhalla RG, Bonnet K, Schlundt D, Johnsen NV. Qualitative Analysis of Patient Experiences Reaching Urethroplasty for Recurrent Urethral Stricture Disease. J Urol 2024; 211:153-162. [PMID: 37792669 DOI: 10.1097/ju.0000000000003722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Despite the inferior outcomes, urethral stricture patients often undergo multiple endoscopic procedures prior to undergoing definitive urethroplasty. We sought to qualitatively evaluate the patient experience of obtaining urethroplasty to better understand the impact of this experience on quality of life. MATERIALS AND METHODS Patients treated with urethroplasty between September 2019 and July 2021 were identified and invited to participate in our study if they had undergone ≥ 2 endoscopic procedures prior to urethroplasty. Semistructured telephone interviews were conducted, coded, and analyzed using an iterative inductive-deductive approach. RESULTS Of the 105 urethroplasty patients during the study period, 50 (47.6%) had undergone ≥ 2 endoscopic procedures prior (IQR 3-5), of whom 20 participated in the study. Qualitative themes related to repeat endoscopic procedures included unmet treatment expectations, dissatisfaction with catheterization and repeat procedures, and negative impacts of recurrent stricture symptoms and treatments on quality of life. External factors associated with a delay to urethroplasty included financial constraints, surgeon access, and time off work. CONCLUSIONS A trajectory of declining quality of life and unmet treatment expectations are the primary factors driving the decision to proceed with urethroplasty. However, external factors such as recovery costs and access to specialists play important roles in delaying surgery. These findings illustrate the need for improved community provider education and patient counseling to better inform expectations of both patients and providers with various treatment outcomes. Furthermore, these data highlight the need to improve access to specialized care for urethral stricture patients.
Collapse
Affiliation(s)
- Abimbola Ayangbesan
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - George E Koch
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chloe Dagostino
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Jack M Proctor
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Helen Gambrah
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Rohan G Bhalla
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - Niels V Johnsen
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
24
|
Chen Y, Hu J, Peng L, Zhao Y. Risk-Factor Analysis and Prediction-Model Construction of Urethral Stricture after Hypospadias Surgery in Children: A Single-Centre Retrospective Study. ARCH ESP UROL 2023; 76:666-673. [PMID: 38053421 DOI: 10.56434/j.arch.esp.urol.20237609.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study aimed to explore the incidence of postoperative urethral stricture in children after hypospadias surgery, analyse its risk factors, and construct a prediction model. METHODS We retrospectively analysed the clinical data of 402 children with hypospadias surgery in Hunan Children's Hospital from January 2022 to January 2023. To explore the risk factors of urethral stricture after hypospadias surgery in children, the incidence of postoperative urethral stricture in children was statistically analysed, and univariate and multivariate logistic regression analyses were adopted. A prediction model was established, and the prediction efficiency of the model was examined using a receiver operating characteristic curve. RESULTS The incidence of postoperative urethral stricture in children after hypospadias surgery was 9.20% (37/402). On this basis, the children were divided into stricture group (SG, n = 37) and normal group (NG, n = 365). Both groups had overt differences in disease classification, urinary tract infection, indwelling-catheter time, and surgical methods (p < 0.05). Logistic regression analysis showed that urinary tract infection, surgical methods, and long indwelling-catheter time were the risk factors (p < 0.001). The prediction model constructed based on the above results had certain prediction efficiency. CONCLUSIONS More attention should be paid to children with urinary tract infection, high-risk surgery, and long indwelling-catheter time after hypospadias surgery. Our prediction model can serve as an effective reference for evaluating the occurrence of postoperative urethral stricture.
Collapse
Affiliation(s)
- Yifu Chen
- Department of Urology, Hunan Children's Hospital, 410013 Changsha, Hunan, China
| | - Jianjun Hu
- Department of Urology, Hunan Children's Hospital, 410013 Changsha, Hunan, China
| | - Liucheng Peng
- Department of Urology, Hunan Children's Hospital, 410013 Changsha, Hunan, China
| | - Yaowang Zhao
- Department of Urology, Hunan Children's Hospital, 410013 Changsha, Hunan, China
| |
Collapse
|
25
|
Wan X, Yao HJ, Xie MK, Ni JS, Gao DJ, Wang Z, Xu B, Zheng DC. A comparative study of two single-stage oral mucosal substitution urethroplasty (Kulkarni and Asopa) in the surgical treatments of lichen sclerosus urethral strictures. Asian J Androl 2023; 25:719-724. [PMID: 37040216 DOI: 10.4103/aja20236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/08/2023] [Indexed: 04/12/2023] Open
Abstract
Long-segment lichen sclerosus (LS) urethral stricture is a challenge for urologists. Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty. In this retrospective study, we investigated the outcomes of these two procedures in patients with LS urethral stricture. Between January 2015 and December 2020, 77 patients with LS urethral stricture underwent Kulkarni and Asopa procedures for urethroplasty in the Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine (Shanghai, China). Of the 77 patients, 42 (54.5%) underwent the Asopa procedure and 35 (45.5%) underwent the Kulkarni procedure. The overall complication rate was 34.2% in the Kulkarni group and 19.0% in the Asopa group, and no difference was observed ( P = 0.105). Among the complications, no statistical difference was observed in the incidence of urethral stricture recurrence ( P = 0.724) or glans dehiscence ( P = 0.246) except for postoperative meatus stenosis ( P = 0.020). However, the recurrence-free survival rate between the two procedures was significantly different ( P = 0.016). Cox survival analysis showed that antiplatelet/anticoagulant therapy use ( P = 0.020), diabetes ( P = 0.003), current/former smoking ( P = 0.019), coronary heart disease ( P < 0.001), and stricture length ( P = 0.028) may lead to a higher hazard ratio of complications. Even so, these two techniques can still provide acceptable results with their own advantages in the surgical treatment of LS urethral strictures. The surgical alternative should be considered comprehensively according to the patient characteristics and surgeon preferences. Moreover, our results showed that antiplatelet/anticoagulant therapy use, diabetes, coronary heart disease, current/former smoking, and stricture length may be contributing factors of complications. Therefore, patients with LS are advised to undergo early interventions for better therapeutic effects.
Collapse
Affiliation(s)
- Xiang Wan
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Jamil ML, Hamsa A, Grove S, Cho EY, Alsikafi NF, Breyer BN, Broghammer JA, Buckley JC, Elliott SP, Erickson BA, Myers JB, Peterson AC, Rourke KF, Voelzke BB, Zhao LC, Vanni AJ. Outcomes of Urethroplasty for Synchronous Anterior Urethral Stricture Utilizing the Trauma and Urologic Reconstruction Network of Surgeons Length, Segment and Etiology Anterior Urethral Stricture Classification System. Urology 2023; 181:155-161. [PMID: 37673405 DOI: 10.1016/j.urology.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To describe the characteristics, management, and functional outcomes of patients with synchronous urethral stricture disease (SUSD) utilizing a multi-institutional cohort. METHODS Data were collected and assessed from a prospectively maintained, multi-institutional database. Patients who underwent anterior urethroplasty for urethral stricture disease (USD) were included and stratified by the presence or absence of SUSD. USD location and etiology were classified according to the Trauma and Urologic Reconstruction Network of Surgeons Length, Segment and Etiology Anterior Urethral Stricture Classification System. Anterior urethroplasty techniques were recorded for both strictures. Functional failure was compared between groups. RESULTS One thousand nine hundred eighty-three patients were identified, of whom, 137/1983 (6.9%) had SUSD. The mean primary stricture length for patients with SUSD was 3.5 and 2.6 cm for the secondary stricture. Twelve anterior urethroplasty technique combinations were utilized in treating the 27 different combinations of SUSD. Functional failure was noted in 18/137 (13.1%) patients with SUSD vs 192/1846 (10.4%) patients with solitary USD, P = .3. SUSD was not associated with increased odds of functional failure. S classifications: S1b, P = .003, S2a, P = .001, S2b, P = .01 and S2c, P = .02 and E classifications: E3a, P = .004 and E6, P = .03, were associated with increased odds of functional failure. CONCLUSION Repair of SUSD in a single setting does not increase the risk of functional failure compared to patients with solitary USD. Increasing S classification, S1b through S2c and E classifications E3a and E6 were associated with increased functional failure. This reinforces the importance of the Trauma and Urologic Reconstruction Network of Surgeons Length, Segment and Etiology Anterior Urethral Stricture Classification System as a necessary tool in large-scale multi-institutional analysis when assessing highly heterogenous patient populations.
Collapse
Affiliation(s)
| | | | | | - Eric Y Cho
- University of California San Diego, San Diego, CA
| | | | | | | | | | | | | | | | | | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Alex J Vanni
- Lahey Hospital and Medical Center, Burlington, MA.
| |
Collapse
|
27
|
Ungerer G, Kemble J, Sischka M, Balzano FL, Warner JN. Endoscopic Urethroplasty Using Buccal Graft for Male Membranous Urethral Stricture. Urology 2023; 181:e200-e203. [PMID: 37532087 DOI: 10.1016/j.urology.2023.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To demonstrate a new minimally invasive endoscopic approach to urethroplasty. METHODS The procedure was performed in a male patient with prior history of prostate cancer managed by radiation who subsequently developed an 8 mm flow-limiting membranous urethral stricture. After stricture dilation a 1 cm wide strip of superficial mucosa was resected from the bladder neck past the area of stricture, creating a bed for the graft to lay. Buccal mucosa graft was harvested in standard fashion. With the graft outside the urethra and using the RD 180 endoscopic suturing device, a suture is placed in the proximal end of the graft, then through the bladder neck, and back through the graft. As the suture is pulled, the pulley phenomenon advances the graft into place on the bladder neck. The graft is then anchored to the posterior urethra with secure straps. A catheter is placed to hold the graft flat during the healing process. RESULTS The procedure lasted 2.5 hours without any complications. Estimated blood loss was 50cc, and the patient was discharged after the procedure. Catheter was removed at 4weeks. Cystoscopy at 10weeks post-op showed good graft viability, with peak flow improving to 20 mL/s compared to 4 mL/s preoperatively. At 6months, he continues to do well without evidence of recurrent urethral stricture. CONCLUSION Endoscopic urethroplasty using buccal graft appears to offer a safe and effective repair option for management of ureteral strictures.
Collapse
|
28
|
Berg EK, Chaloupka M, Götz M, Hoffmann M, Askari-Motlagh D, Stief CG, Bischoff R. [Etiology, diagnostic pathway and treatment of urethral strictures in men]. MMW Fortschr Med 2023; 165:66-69. [PMID: 37828336 DOI: 10.1007/s15006-023-2942-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- Elena K Berg
- Urologische Klinik und Poliklinik, Campus Großhadern der LMU München - Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - Michael Chaloupka
- Urologische Klinik und Poliklinik für Urologie, Campus Großhadern der LMU München, Marchioninistraße 15, 81377, München, Deutschland
| | - Melanie Götz
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Marchioninistraße 15, 81377, München, Deutschland
| | - Marina Hoffmann
- Urologische Klinik und Poliklinik, Campus Großhadern der LMU München, Marchioninistraße 15, 81377, München, Deutschland
| | - Darjusch Askari-Motlagh
- Urologische Klinik und Poliklinik, Campus Großhadern der LMU München, Marchioninistraße 15, 81377, München, Deutschland
| | - Christian G Stief
- Urologische Klinik und Poliklinik für Urologie, Klinik der Universität München, Campus Großhadern, Marchioninistraße 15, 81377, München, Deutschland
| | - Robert Bischoff
- Urologische Klinik und Poliklinik für Urologie, Klinikum Großhadern er LMU München, Marchioninistr. 15, 81377, München, Deutschland
| |
Collapse
|
29
|
Taha TM, Ali MO, Shahat AA, Abdalla MA, Hammouda HM, Behnsawy HM. Does primary urethral realignment improve the outcome of pediatric pelvic fracture urethral injury? A randomized controlled trial. Int J Urol 2023; 30:922-928. [PMID: 37365775 DOI: 10.1111/iju.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To assess the efficacy of primary urethral realignment in the prevention of urethral stenosis and in simplifying delayed urethroplasty after complete pelvic fracture urethral injury in male children. METHODS This randomized comparative trial included 40 boys <18 years with complete pelvic fracture urethral injury. The initial management was a primary urethral realignment in 20 boys and suprapubic cystostomy alone in the remaining 20 boys. The boys who underwent primary urethral realignment were assessed regarding the development of urethral stenosis. Boys who needed to be delayed urethroplasty in the two groups were compared regarding urethral defect length, intraoperative details, postoperative outcomes, number of procedures, and time to achieve normal voiding. RESULTS Although 14 (70%) patients were able to void after primary urethral realignment, all of them developed urethral stenosis and needed delayed urethroplasty. No statistically significant difference between the two groups was found regarding urethral defect length, intraoperative details, and postoperative outcomes. Patients in the primary urethral realignment group underwent significantly more procedures (p < 0.001) and took a significantly longer time to achieve normal voiding (p = 0.002). CONCLUSION Primary urethral realignment is neither able to prevent urethral stenosis nor effective in simplifying later urethroplasty after complete pelvic fracture urethral injury in male children. It exposes the patients to more surgical procedures and a prolonged clinical course.
Collapse
Affiliation(s)
- Taha M Taha
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed O Ali
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A Shahat
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Medhat A Abdalla
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hisham M Hammouda
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hosny M Behnsawy
- Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt
| |
Collapse
|
30
|
Abidi SS, Gazder T, Hussain M, Rabiullah S, Zulfiqar M, Hasan Rizvi SA. Epidemiology Of Male Urethral Strictures In Pakistan. J PAK MED ASSOC 2023; 73:2054-2058. [PMID: 37876069 DOI: 10.47391/jpma.7925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Urethral stricture disease is relatively common in Pakistan, constituting 4-5% of the urological workload. Despite the high prevalence, little is known about its epidemiology in the country. The current narrative review comprised search on PubMed, Pak MediNet and Google Scholar databases for studies done in Pakistan and published between January 1, 2000, and December 31, 2021. The search yielded 30 local publications on stricture urethra. Demographic data as well as causes and management pattern of male urethral stricture were noted and analysed. There were 5,021 patients, with 3850 (76.6%) being from the province of Sindh. The disease had the greatest impact on younger patients aged up to 40 years (n=1572), while after the age of 60 years, 248 (9%) patients had the disease. The common cause was trauma due to road traffic accidents in both anterior and posterior strictures compared to idiopathic cause reported in the West. Infection 170 (6.9%) and Lichen sclerosis 123(4.5%) as a cause was found to decline in our region. A clinic-based regular urethral dilatation was still in practice at some centres to manage such cases. Vast majority of stricture patients were being treated by endoscopic procedures, and only 1154 (23%) cases underwent urethroplasty.
Collapse
Affiliation(s)
- Syed Saeed Abidi
- Department of Urology, Sindh Institute of Urology & Transplantation (SIUT), Karachi, Pakistan
| | - Tanzeel Gazder
- Department of Urology, Sindh Institute of Urology & Transplantation (SIUT), Karachi, Pakistan
| | - Manzoor Hussain
- Department of Urology, Sindh Institute of Urology & Transplantation (SIUT), Karachi, Pakistan
| | - Syed Rabiullah
- Department of Urology, Sindh Institute of Urology & Transplantation (SIUT), Karachi, Pakistan
| | - Mazahir Zulfiqar
- Department of Urology, Sindh Institute of Urology & Transplantation (SIUT), Karachi, Pakistan
| | - Syed Adibul Hasan Rizvi
- Department of Urology, Sindh Institute of Urology & Transplantation (SIUT), Karachi, Pakistan
| |
Collapse
|
31
|
Marks P, Dahlem R, Janisch F, Klemm J, Kühnke L, König F, Ding L, Riechardt S, Fisch M, Vetterlein MW. Mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures. BJU Int 2023; 132:444-451. [PMID: 37409824 DOI: 10.1111/bju.16112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVES To present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long-term objective and patient-reported outcomes. PATIENTS AND METHODS We considered patients undergoing bulbar buccal mucosal graft urethroplasty (BMGU) between July 2016 and December 2019. Eligibility criteria for mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty were strictures of ≥2 cm with an obliterative segment of ≤1.5 cm. The stricture is approached ventrally to avoid extensive dissection and mobilisation. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated patient-reported outcome measures on voiding, erectile, and continence function. We evaluated functional follow-up, incorporating patient-reported (lower urinary tract symptoms [LUTS] score) and functional success. Recurrence was defined as need of re-treatment. RESULTS Of 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a history of dilatation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%), and the mean (SD) graft length was 4.5 (1.4) cm. At a median (interquartile range) follow-up of 41 (27-53) months, the functional success rate was 93%. Whereas the median LUTS score significantly improved from baseline to postoperatively (13 vs 3.5; P < 0.001), there was no change in erectile function (median International Index of Erectile Function - erectile function domain score 27 vs 24) or urinary continence (median International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form sum score 0 vs 0; all P ≥ 0.4). All patients were 'satisfied' (27%) or 'very satisfied' (73%) with the outcome of their operation. CONCLUSION With excellent long-term objective and patient-reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.
Collapse
Affiliation(s)
- Phillip Marks
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Florian Janisch
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jakob Klemm
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Lennart Kühnke
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Frederik König
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Liucheng Ding
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Silke Riechardt
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
- Department of Urology, Medical Center Itzehoe, Itzehoe, 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
| |
Collapse
|
32
|
Chaker K, Ouanes Y, Chedly WB, Bibi M, Mosbahi B, Fakhfakh H, Abed WE, Hriz A, Rahoui M, Dali KM, Ammous A, Nouira Y. [Outcomes of early endoscopic realignment of post-traumatic posterior urethral ruptures]. Prog Urol 2023; 33:469-473. [PMID: 37634959 DOI: 10.1016/j.purol.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/16/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Post-traumatic rupture of the posterior urethra is a serious injury that can compromise the micturition and erectile prognosis of the often-young patient. The management of this lesion is still controversial, leaving the choice between early endoscopic realignment or suprapubic catheterization with deferred urethroplasty. The objective of this study was to report our clinical experience and outcomes with early endoscopic realignment (EER) for patients with pelvic fracture urethral injury. PATIENTS AND METHODS We underwent a retrospective review of patients with pelvic fracture associated urethral injury who underwent EER from 2010 to 2020. Preoperative, perioperative, and postoperative outcome data were collected. Complications for the surgical procedure were analyzed, as well as postoperative stenosis, urinary incontinence and erectile dysfunction. The primary endpoint was success, defined as satisfying micturition with no urethral stricture at the time of last follow-up. RESULTS Early endoscopic realignment was performed in 26 patients managed for complete post-traumatic posterior urethral rupture. The median age was 26 (16-39) years. The most common mechanism of urethral injury was road traffic accidents in 69.23% of cases. The most common urethral injury was grade 4 in 23 patients (88.46%). The median time to endoscopic realignment was 8 days (3-18). The median time to postoperative bladder catheterization was 22 (10-32) days. The median follow-up time was 34 (18-54) months. Ten patients developed urethral stricture during follow-up: 7 (26.92%) were treated with one or two internal cold blade urethrotomies, 3 required urethroplasty. There were no urethroplasty failures after a first endoscopic realignment. Two patients reported severe stress urinary incontinence. The median IIEF-5 score at the date of last news was 23 (17-25). CONCLUSION Early endoscopic realignment allows some patients to avoid a heavier surgical treatment, and doesn't compromise the realization of a later urethroplasty. LEVEL OF EVIDENCE: 3
Collapse
Affiliation(s)
- Kays Chaker
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie.
| | - Yassine Ouanes
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Wassim Ben Chedly
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Mokhtar Bibi
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | - Boutheina Mosbahi
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Hend Fakhfakh
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Wiem El Abed
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Aziz Hriz
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Moez Rahoui
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| | | | - Adel Ammous
- Service d'anesthésie-réanimation, CHU de La Rabta, université de Tunis El Manar, Tunis, Tunisie
| | - Yassine Nouira
- Service d'urologie, CHU de La Rabta, Université de Tunis El Manar, Tunis, Tunisie
| |
Collapse
|
33
|
Coguplugil AE, Zor M, Gurdal M. Buccal mucosa graft tube urethroplasty for the treatment of bulbopenile urethral trauma accompanied with massive tissue loss due to improvised explosive device injury. Aktuelle Urol 2023; 54:395-397. [PMID: 34256412 DOI: 10.1055/a-1490-5244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Urinary diversion with suprapubic cystostomy and delayed urethroplasty is recommended for the treatment of penetrating posterior urethral traumas. A devastating urethral trauma caused by a blast injury due to an improvised explosive device is an extremely rare clinical condition and treatment options are limited due to accompanying massive tissue and muscle loss. Staged urethral reconstruction using a pedicled gracilis muscle flap with a skin or buccal mucosa graft is the preferred treatment option for complex urethral traumas. In case of a devastated urethra due to an intensive explosive device injury, treatment options are limited, especially if the gracilis muscle cannot be used. We report the case of a 30-year-old male patient with a devastated bulbopenile urethra and massive local tissue and adjacent muscle loss including the gracilis muscle. The patient was successfully treated by buccal mucosa graft tube urethroplasty. Urethral stricture recurred but was successfully treated by means of endoscopy. At 24 months' follow-up, the patient was continent and urinated normally.
Collapse
Affiliation(s)
| | - Murat Zor
- Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| | - Mesut Gurdal
- Urology, Gulhane Research and Training Hospital, Ankara, Turkey
| |
Collapse
|
34
|
Reddy SA, Holdren C, Srikanth P, Crane CN, Santucci RA. Urethroplasty Methods for Stricture Repair After Gender Affirming Phalloplasty: High Failure Rates in a Hostile Surgical Field. Urology 2023; 179:196-201. [PMID: 37414225 DOI: 10.1016/j.urology.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To report our experience with 71 postphalloplasty urethral strictures in order to discuss the performance characteristics of different urethroplasty techniques in urethral stricture after phalloplasty. METHODS We conducted a retrospective chart review of 85 urethroplasties performed for stricture repair in 71 patients with phalloplasty for gender affirmation between August 2017 and May 2020. Stricture location, urethroplasty type, complication rate, and recurrence rate were recorded. RESULTS The most common stricture type was distal anastomotic (40/71, 56%). The most common initial repair type was excision and primary anastomosis (EPA) (33/85, 39%), followed by first-stage Johanson urethroplasty (32/85, 38%). The stricture recurrence rate after initial repair of all types was 52% (44/85). The recurrence rate of stricture after EPA was 58% (19/33). The recurrence rate after staged urethroplasty was 25% (2/8) for patients who successfully completed a first and second stage. 30% (3/10) of patients who completed a first stage and opted out of a second stage required a revision to achieve successful lifetime voiding from the surgical urethrostomy. CONCLUSION EPA after phalloplasty has a high failure rate. Nontransecting anastomotic urethroplasty has slightly lower failure rate, and staged Johanson-type surgeries have the highest success rates after phalloplasty.
Collapse
Affiliation(s)
- Soumya A Reddy
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | | | - Pooja Srikanth
- University of Minnesota, Department of Urology, Minneapolis, MN
| | | | | |
Collapse
|
35
|
Jamil ML, Perecman A, Sherman A, Sullivan T, Christ K, Hansma A, Burks E, Vanni AJ. Urinary microbiome differences between lichen sclerosus induced and non-lichen sclerosus induced urethral stricture disease. World J Urol 2023; 41:2495-2501. [PMID: 37421420 DOI: 10.1007/s00345-023-04490-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/09/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE To describe differences in the urinary microbiome of patients with pathologically confirmed lichen sclerosus (LS) urethral stricture disease (USD) vs non-lichen sclerosus (non-LS) USD pre- and post-operatively. METHODS Patients were pre-operatively identified and prospectively followed, all underwent surgical repair and had tissue samples obtained to make a pathological diagnosis of LS. Pre- and post-operative urine samples were collected. Bacterial genomic DNA was extracted. Alpha and beta diversity measurements were calculated and compared. A zero-inflated negative binomial model was utilized to compare taxa abundances between disease status and surgery status. RESULTS Urine samples were obtained from both cohorts, 69 samples in total: 36 samples were obtained pre-operatively and 33 samples were obtained post-operatively. Ten patients provided both a pre-operative and post-operative urine sample. Twenty-six patients had pathological evidence of LS and 33 patients did not. There was a statistically significant difference in alpha diversity between the pre-operative urine samples of patients with non-LS USD and LS USD, (p = 0.01). There was no significant difference in alpha diversity within post-operative urine samples between patients with non-LS USD and LS USD, (p = 0.1). A significant difference was observed in Weighed UniFrac distances with respect to disease and operative status, (p = 0.001 and 0.002). CONCLUSIONS LS USD have significant alterations in diversity and differential abundance of urine microbiota compared to non-LS USD controls. These findings could be used to guide further investigations into the role of the urinary microbiome in LS USD pathogenesis, severity of presentation, and stricture recurrence.
Collapse
Affiliation(s)
- Marcus L Jamil
- Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Aaron Perecman
- Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Amanda Sherman
- Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Travis Sullivan
- Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Kimberly Christ
- Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Alexandra Hansma
- Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
- Tufts University, Medford, MA, USA
| | - Eric Burks
- Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
- Tufts University, Medford, MA, USA
- Boston Medical Center, Boston, Massachusetts, USA
| | - Alex J Vanni
- Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA.
| |
Collapse
|
36
|
Wuillemin F, Vachon C, Dunn M, Desrochers A. Management of obstructive urethroliths, urethral pseudodiverticulum, and stricture by diverticulectomy, urethroplasty, and urethral stenting placement in a male goat. Can Vet J 2023; 64:733-741. [PMID: 37529384 PMCID: PMC10352047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
A 5-year-old wether was presented for an acute onset of loss of appetite and inability to urinate. Urethral urolithiasis causing urethral obstruction was diagnosed and a cystostomy catheter was placed. The wether continued to be unable to urinate through the urethra and further developed a perineal pseudodiverticulum. Diverticulectomy followed by a urethroplasty using porcine small intestinal submucosa was performed to relieve the obstruction. The wether developed a urethral stricture following urethroplasty and the owners refused a perineal urethroplasty. Cystourethrography, fluoroscopic-guided balloon dilations, and urethral stent placement were done to establish urethral patency. The wether developed tissue ingrowth through the stent, resulting in recurrent obstruction that necessitated placement of covered urethral stents. Key clinical message: Although obstructive uroliths usually carry a guarded prognosis in small ruminants, the use of novel interventional radiology techniques along with urethroplasty using a xenograft allowed a wether to achieve urethral patency and normal urinations.
Collapse
Affiliation(s)
- Florian Wuillemin
- Department of Clinical Sciences, School of Veterinary Medicine, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2
| | - Catherine Vachon
- Department of Clinical Sciences, School of Veterinary Medicine, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2
| | - Marilyn Dunn
- Department of Clinical Sciences, School of Veterinary Medicine, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2
| | - André Desrochers
- Department of Clinical Sciences, School of Veterinary Medicine, Université de Montréal, 3200, rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2
| |
Collapse
|
37
|
Barnard J, Liaw A, Gelman J. Long-term follow-up suggests high satisfaction rates for bulbomembranous radiation-induced urethral stenoses treated with anastomotic urethroplasty. World J Urol 2023; 41:1905-1912. [PMID: 37314572 PMCID: PMC10352169 DOI: 10.1007/s00345-023-04429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/18/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE To analyze patients who underwent anastomotic urethroplasty for radiationinduced bulbomembranous urethral stricture/stenosis (RIS) due to prostate cancer treatment with up to 19 years of follow-up and assess long-term patient reported outcomes (PROMs). Long-term follow-up with the inclusion of urethroplasty specific PROMs is lacking in the available research. METHODS Patients who underwent anastomotic urethroplasty for RIS were identified from 2002 to 2020. Inclusion criteria included completion of 4-month post-operative cystoscopy and PROMs including IPSS, SHIM, MSHQ-EF, 6Q-LUTS, and global satisfaction queries at 4 months. PROMs were assessed annually thereafter, and cystoscopy was performed for adverse change in PROMs or worsening uroflow/PVR parameters. PROMs were compared at pre-op, post-op, and most recent follow-up. RESULTS 23 patients met inclusion criteria. Short-term anatomic success was 95.7%. At a mean follow-up of 73.1 months (9.1-228.9), one late recurrence occurred for an overall success of 91.3%. Significant and sustained objective improvement was identified in voiding scores, quality of life, and urethroplasty specific PROMs. Satisfaction was 91.3% despite sexual side effects, and 95.7% of patients stated they would have surgery again knowing their outcome at a mean of over 6 years' follow up. CONCLUSIONS RIS are challenging problems, but durable symptomatic relief is achievable in well-selected patients. Patients with bulbomembranous RIS should be appropriately counseled regarding the risk of urinary incontinence and sexual side effects after anastomotic urethroplasty. However, long-term success is high, and overall QoL will have sustained subjective improvement in most cases.
Collapse
Affiliation(s)
- John Barnard
- West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Aron Liaw
- University of California-Irvine, Irvine, CA, USA
| | | |
Collapse
|
38
|
Westin LA, Boechat J, Gabrich P, Figueiredo F, Favorito LA. Preliminary results of a new surgical technique: bladder mucosal graft harvested with holmium:YAG (HO:YAG) laser. A new option in bulbar replacement urethroplasty? Int Braz J Urol 2023; 49:501-510. [PMID: 37171827 PMCID: PMC10482450 DOI: 10.1590/s1677-5538.ibju.2023.9906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE To describe the technique of transurethral harvesting of bladder mucosal graft using the Holmium:YAG (Ho-YAG) laser and describe the preliminary results from 7 cases where this graft was used for urethroplasty. MATERIALS AND METHODS We performed a single-stage dorsal onlay urethroplasty using bladder mucosal graft in 7 patients with anterior urethral stricture. Transurethral harvesting was performed with the Ho-YAG laser. We performed a prospective and descriptive analysis with uroflowmetry performed at 30, 90 and 180 days after surgery and applied the PROM translated into Portuguese before and 6 months after urethroplasty. RESULTS Seven patients were included, 2 (28.5%) with penile urethral stricture, and 5 (71.5%) with bulbar urethral stricture. Mean stricture length was 50mm (range 35-60mm). Stricture etiology was trauma in 3 (42.9%) patients, iatrogenic in 1 (14.3%) patient, and idiopathic in 3 (42.9%) patients. Two patients (28.6%) had previously undergone ventral buccal mucosa urethroplasty. Mean bladder mucosal graft length was 52.86mm (± 13.801), and mean harvest time was 46.43min (± 14.639). Dorsal onlay urethroplasty using bladder mucosa was successfully completed in 5 patients (71.4%). Two patients (28.6%) couldn't have the procedure completed using bladder mucosa, one due to thermal damage of the graft during harvesting, and one due to insufficient graft length. In both cases the procedure was completed using buccal mucosa. Two patients (28.6%) experienced minor hematuria between the twelfth and eighteenth postoperative day, but neither required hospitalization and/or additional procedures. All patients achieved normalization of peak flow, and this was maintained throughout the follow-up period. Mean peak flow was 17.8 ml/s (± 3.271) at 30 days, 20.6 ml/s (± 5.413) at 90 days, and 19.6 ml/s (± 8.019) 180 days. Mean IPSS score decreased from 19.3 to 5.4. Similar improvements were also seen in the ICIQ-MLUTS Score (a mean drop from 3.8 to 2.0) and Peeling's Voiding Picture Score (a mean drop from 4.0 to 2.2). Quality of Life improved post urethroplasty, with increases in EQ-5D (from 0.6371 to 0.7285) and EQ-VAS (from 58.0 to 84.0). CONCLUSION Transurethral harvesting of bladder mucosa using the Holmium laser (Ho-YAG) is feasible and reproducible. Our preliminary experience suggests that bladder mucosa grafts achieve comparable results to other grafts when used for dorsal onlay urethroplasty. Further research is needed to confirm these results.
Collapse
Affiliation(s)
- Luiz Augusto Westin
- UERJHospital Universitário Pedro ErnestoServiço de UrologiaRio de JaneiroRJBrasilServiço de Urologia, Hospital Universitário Pedro Ernesto, UERJ Rio de Janeiro, RJ, Brasil
| | - João Boechat
- UERJHospital Universitário Pedro ErnestoServiço de UrologiaRio de JaneiroRJBrasilServiço de Urologia, Hospital Universitário Pedro Ernesto, UERJ Rio de Janeiro, RJ, Brasil
| | - Pedro Gabrich
- UERJHospital Universitário Pedro ErnestoServiço de UrologiaRio de JaneiroRJBrasilServiço de Urologia, Hospital Universitário Pedro Ernesto, UERJ Rio de Janeiro, RJ, Brasil
| | - Felipe Figueiredo
- Hospital PompéiaServiço de UrologiaCaxias do SulRSBrasilServiço de Urologia, Hospital Pompéia, Caxias do Sul, RS, Brasil
| | - Luciano Alves Favorito
- Universidade Estadual do Rio de JaneiroUnidade de Pesquisa UrogenitaRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
39
|
Zhang LF, Zhan SY. [Analysis of risk factors of urethral stricture and urinary incontinence after transurethral resection of the prostate]. Zhonghua Nan Ke Xue 2023; 29:619-624. [PMID: 38619409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The purpose of this study was to analyze the risk factors for predicting urethral stricture and urinary incontinence after transurethral resection of the prostate (TURP). METHODS A retrospective study of 261 patients admitted from October 2018 to October 2022 who received TURP for benign prostatic hyperplasia (BPH) with complete postoperative follow-up data of at least 6 months. Patients were divided into urethral stricture group (n =18), non-urethral stricture group (n =243), urinary incontinence group (n = 12) and non-urethral incontinence group (n = 249) according to the presence of urethral stricture and urinary incontinence. Compared two groups of patient's age, course of the disease, hypertension, diabetes mellitus, IPSS score, prostate volume, maximum urine flow rate, whether preoperative urinary retention, total prostate specific antigen levels and whether preoperative status, placing a urinary catheter preoperative whether merger urinary tract infection, operative time, postoperative time, postoperative urine tube drawing time placing a urinary catheter, etc. Univariate and multivariate Logistic regression analyses were used to screen for independent predictors. RESULTS The incidence of urethral stricture and urinary incontinence after TURP was 6.9% and 4.6%, respectively. Multivariate logistic regression analysis showed that diabetes mellitus (OR = 9.526, 95%CI: 2.824-32.127, P= 0.000); Preoperative urethral infection (OR = 6.500, 95%CI: 1.513-27.925, P = 0.012); Postoperative indwelling catheter time (OR = 2.063, 95%CI: 1.181-3.601, P = 0.011) was an independent risk factor for postoperative urethral stricture. Age (OR = 1.21, 95%CI: 1.027-1.425, P = 0.023); Diabetes mellitus (OR = 37.515, 95%CI: 2.615-538.170, P = 0.008); Postoperative indwelling catheter time (OR = 20.806, 95%CI: 3.090-140.080, P = 0.002) was an independent risk factor for postoperative urinary incontinence. CONCLUSIONS Urethral stricture and urinary incontinence are common complications after TURP. Diabetes, preoperative urethral infection, and postoperative catheter indwelling time are independent risk factors for urethral stricture after TURP. Age, diabetes mellitus and postoperative catheter indwelling time were independent risk factors for postoperative urinary incontinence. Diabetes mellitus and postoperative catheter indwelling were common and independent risk factors for urethral stricture and urinary incontinence after TURP.
Collapse
Affiliation(s)
- Lu-Feng Zhang
- Department of Urology, Heifei BOE Hospital, Hefei, Anhui 230000, China
| | - Shao-Yang Zhan
- Department of Urology, Heifei BOE Hospital, Hefei, Anhui 230000, China
| |
Collapse
|
40
|
Wang J, Xu X, Bao Z, Liu Z, Li G, He F. Lateral incision 1-stage urethroplasty with oral mucosal graft for patients with penile urethral stricture after hypospadias repair-a preliminary report. BMC Urol 2023; 23:75. [PMID: 37118771 PMCID: PMC10148384 DOI: 10.1186/s12894-023-01250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/17/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE To report our early experience of a novel surgical approach for penile urethral strictures after hypospadias repair, using a lateral incision to keep the ventral tissue and vasculature of the penis intact and to avoid the need for tissue interposition. PATIENTS AND METHODS A total of 21 patients underwent lateral incision 1-stage urethroplasty with oral mucosal graft. The median age of the patients was 21 years old (range, 13-47). The median number of prior procedures for hypospadias repair was 3 (range, 1-9) with 18 of 21 patients (85.7%) undergoing greater than 1 prior reconstructive procedure. The mean length of the penile urethral strictures was 4.5 ± 1.7 cm, with a range of 1.0 to 8.0 cm. Selection criteria for lateral incision 1-stage urethroplasty include: non-obliterative stricture, no or mild penile curvature and no urethrocutaneous fistula. RESULTS Median follow-up was 30 months (range, 6-73). Success was achieved in 17 of 21 patients (80.9%). The 4 (19.0%) patients with treatment failure developed recurrent urethral strictures. Of the 4 men with recurrent strictures, 3 were ultimately treated successfully by DVIU (2) or two-stage urethroplasty (1), and one patient chose repeated dilation. CONCLUSIONS For patients with penile urethral stricture after hypospadias repair with non-obliterative stricture, no significant penile curvature and no urethrocutaneous fistula, a lateral approach with oral mucosal graft is a simple technique that avoids the need for tissue interposition and keeps the penile ventral tissue and vasculature intact, resulting in a low risk of complications.
Collapse
Affiliation(s)
- Jianwei Wang
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Xiao Xu
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Zhengqing Bao
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Zhenhua Liu
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Guizhong Li
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| | - Feng He
- Department of Urology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No.68 Huinanbei Road, Changping District, Beijing, China
| |
Collapse
|
41
|
Ponce de León J, Salas D, Calderón J, Montlleó M, Palou J. Analysis of prognostic factors of failure in perineal urethrostomy. World J Urol 2023; 41:1109-1115. [PMID: 36932283 DOI: 10.1007/s00345-023-04343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/17/2023] [Indexed: 03/19/2023] Open
Abstract
PURPOSE To identify prognostic factors of failure in patients undergoing perineal urethrostomy (PU) with Blandy technique, with inverted U-shaped perineal flap. METHODS This is a retrospective study of PU of non-oncological causes (2001-2017). Data of age, BMI, history of diabetes mellitus, etiology of urethral stricture, type of stricture, previous surgeries, dilatation and suprapubic catheter were collected. Failure was defined as the need for any instrumentation after surgery. Variables were analyzed by Cox regression and Kaplan-Meier curves were used for survival analysis. RESULTS A total of 115 PU were performed. Median age was 61 years (IQR 53-68) and BMI 27.9 (IQR 25-30.9). The most frequent etiologies were: lichen sclerosus (30.4%), iatrogenic (27%), and idiopathic (25.7%). 62.6% had panurethral stricture. There were no complications in 73%. Clavien I complications occurred in 25.2%, Clavien II in 0.9% and Clavien IVa in 0.9%. The overall success rate was 51.3% with a median follow-up of 71 months. In the last 8 years, it was 75%. In the multivariate analysis, we found that age (p = 0.01), BMI (p = 0.01), date of surgery (p = 0.01), and suprapubic catheter (p = 0.003) were predictive variables. The voiding satisfaction rate was 88.7%. CONCLUSIONS PU with Blandy technique is a surgery with low morbidity. During the entire study period, it had a failure rate of 48.7% but the failure rate decreased to 25% over the last 8 years. Age, BMI, date of surgery and suprapubic catheter are the most important prognostic factor of failure.
Collapse
Affiliation(s)
| | - Daniel Salas
- Fundació Puigvert, C/Cartagena 340-350, 08034, Barcelona, Spain
| | - Julio Calderón
- Fundació Puigvert, C/Cartagena 340-350, 08034, Barcelona, Spain
| | - María Montlleó
- Fundació Puigvert, C/Cartagena 340-350, 08034, Barcelona, Spain
| | - Juan Palou
- Fundació Puigvert, C/Cartagena 340-350, 08034, Barcelona, Spain
| |
Collapse
|
42
|
Purnomo AF, Satyagraha P, Seputra KP. Complex Complicated Posterior Urethral Stricture with Contracted Bladder and Prostatorectal Fistula: How Do We Manage It? Med Arch 2023; 77:493-495. [PMID: 38313109 PMCID: PMC10834049 DOI: 10.5455/medarh.2023.77.493-495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024] Open
Abstract
Background Posterior traumatic urethral strictures due to PFUI have a wide variety of complication, such as erectile dysfunction, incontinence, bulbar urethral necrosis, and fistula. Bulbar urethral necrosis caused by inadequate blood supply for bulbar urethra, fistula developed by many surgical attempts done by inexperience surgeon worsen the patient's condition, low vascular capability manifested as erectile dysfunction as well, and long term catheterization causes contracted bladder. This condition deteriorates the function and quality of life. Therefore this is very challenging condition to treat. Case Presentation Thirty-years-old man presented with the chief complaint of urine leakage from rectum and cutaneous fistula since 9 years ago. Patient also come with complex PFUI, iatrogenic bulbar urethral necrosis, erectile dysfunction with EHS score of 1, contracted bladder, and prostatorectal fistula. Patient underwent eight various surgical procedures including open surgery and internal urethrotomy previously. We performed cystoprostatectomy and fistula repair transabdominally. Continent cutaneous stoma ileal neobladder with Mansoura approach was performed afterwards. Patient was counselled and educated on how to do clean intermittent self-catheterization, patient was fully satisfied with his bladder function which increase quality of life. Conclusion In this case of BUN with contracted bladder and prostatorectal fistula, continent cutaneous stoma is an option to improve patient's quality of life. PFUI could be treated with high success rate if treated properly from the beginning, more intervention by inexperience surgeon could deteriorate success rate and also quality of life.
Collapse
Affiliation(s)
- Athaya Febriantyo Purnomo
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital Malang, Indonesia
| | - Paksi Satyagraha
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital Malang, Indonesia
| | - Kurnia Penta Seputra
- Department of Urology, Faculty of Medicine Universitas Brawijaya, Saiful Anwar General Hospital Malang, Indonesia
| |
Collapse
|
43
|
Drye N, Lee L, Gkentzis A. From nephrostomy to urethra: overcoming a radiotherapy-induced urethral stricture with a rendezvous technique. Ann R Coll Surg Engl 2023; 105:79-81. [PMID: 35446162 PMCID: PMC9773291 DOI: 10.1308/rcsann.2021.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- N Drye
- Bolton NHS Foundation Trust, UK
| | - L Lee
- Bolton NHS Foundation Trust, UK
| | | |
Collapse
|
44
|
Abbasi B, Shaw NM, Lui JL, Li KD, Sudhakar A, Low P, Hakam N, Nabavizadeh B, Breyer BN. Posterior urethral stenosis: a comparative review of the guidelines. World J Urol 2022; 40:2591-2600. [PMID: 36018366 PMCID: PMC9617833 DOI: 10.1007/s00345-022-04131-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE We aimed to provide a thorough comparative review of the available guidelines on the diagnosis, management, and follow-up for patients with posterior urethral stenosis by the American Urologic Association (2016), Société Internationale d'Urologie (2010), and European Urologic Association (2022). METHODS The AUA, SIU, and EAU guidelines were evaluated for recommendations on the diagnosis, evaluation, and treatment of posterior urethral stenosis. We also included the EAU and AUA urologic trauma guidelines for the trauma-related stenosis. The level or strength of recommendations is included in case of disparity between the guidelines. RESULTS The three guidelines align considerably in recommendations provided for the diagnosis, management, and follow-up of patients with posterior urethral stenosis. SIU and EAU emphasize the role of repeat endoscopic treatment in guidelines compared to AUA. CONCLUSION The preferred method to repair bulbo-membranous stricture/stenosis following radiation therapy remains an area of active interest, focusing on continence preservation. Additionally, there may be a role for advanced endoscopic treatments with or without adjunct therapies to manage even obliterated stenoses.
Collapse
Affiliation(s)
- Behzad Abbasi
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington DC, USA
| | - Jason L Lui
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Architha Sudhakar
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Patrick Low
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.
| |
Collapse
|
45
|
Glukhov VP, Kogan MI, Ilyash AV, Bugaenko VA. [Comparative analysis of patients with spongy urethral strictures undergoing multistage urethroplasty or permanent urethrostomy]. Urologiia 2022:10-14. [PMID: 36098583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Deciding on the optimal surgical method for treating complex spongy urethral strictures is a challenging clinical task. PURPOSE OF THE STUDY To determine the clinical differences between patients undergoing multistage urethroplasty and permanent urethrostomy. MATERIALS AND METHODS Two groups of patients were formed for the analysis: group I - 73 patients who underwent multistage urethroplasty; group II - 48 patients underwent permanent urethrostomy. The differences between groups were studied according to the following clinical parameters: age, body mass index, duration of the disease, previous treatment, etiology, length and localization of strictures, complications of stricture disease, concomitant diseases, urine flow parameters, the presence of early postoperative complications, and recurrence of strictures. RESULTS Patients of group I compared to group II are significantly younger (43.0 vs 59.6 years; p<0.0001). They have fewer idiopathic strictures (8.2 vs 31.3%; p=0.001), undergo cystostomy less often (26.0 vs 54.2%; p=0.002), have less pronounced lower urinary tract symptoms (I-PSS - 18.6 vs 23.8 points; p<0.0001, QoL 4.3 vs 5, 1 point; p<0.0001) and impaired urination parameters (Qmax - 8.1 vs 6.5 ml/s; p=0.09, Qave - 5.5 vs 4.1 ml/s; p=0.015, PVR - 62.4 vs 126.0 ml; p=0.03). The incidence of concomitant diseases (69.9 vs 87.5%; p<0.025) and their number (1.8 vs 3.1; p<0.002) are significantly higher in group II. Among the comorbidities, cardiovascular diseases (31.5 vs 58.3%; p=0.015), diabetes mellitus (5.5 vs 16.7%; p=0.045) and prostatic hyperplasia (8.2 vs 27.1%; p=0.005) predominate. Early surgical complications in group I were detected in 28,8% of patients, in group II - in 2.1% (p<0,0001) of cases. The primary treatment success among patients with permanent urethrostomy is higher than with multistage urethroplasty (85.4 vs 65,8%; p=0,017). CONCLUSIONS It is advisable to perform multistage surgery of extended spongy urethral strictures in young and middle-aged men without serious comorbidities in cases of conscious choice and sufficient awareness. Urethrostomy should initially be discussed with the patient as the operation of choice, considering age, cardiovascular comorbidity, diabetes mellitus and prostatic hyperplasia.
Collapse
Affiliation(s)
- V P Glukhov
- Department of Urology and Pediatric Urology, Rostov State Medical University, Rostov-on-Don, Russia
| | - M I Kogan
- Department of Urology and Pediatric Urology, Rostov State Medical University, Rostov-on-Don, Russia
| | - A V Ilyash
- Department of Urology and Pediatric Urology, Rostov State Medical University, Rostov-on-Don, Russia
| | - V A Bugaenko
- Department of Urology and Pediatric Urology, Rostov State Medical University, Rostov-on-Don, Russia
| |
Collapse
|
46
|
Palminteri E, Preto M, Mari A, Lenci N, Vitelli D, Iacovelli V, Bove P, Buffi N, Cindolo L. Non-transecting dorsal mucosal anastomosis plus ventral oral graft for the treatment of urethral bulbar strictures: single surgeon experience. Int Urol Nephrol 2022; 54:3171-3177. [PMID: 35962907 DOI: 10.1007/s11255-022-03257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To report our experience with the non-transecting dorsal mucosal anastomosis plus ventral oral graft urethroplasty (NTAVOG) for the repair of tight bulbar urethral strictures. METHODS Data of 68 men with tight bulbar strictures underwent NTAVOG urethroplasty between 2012 and 2019 were retrospectively revised. The urethra was opened ventrally; the dorsal scarred mucosa was excised preserving the spongiosum; the mobilized mucosal edges were anastomosed to recreate the dorsal urethral plate; the repaired urethral plate was augmented by the ventral oral graft and the spongiosum was closed over it. Successful urethral reconstruction was defined as normal voiding without the need for any postoperative procedure. Sexual function was investigated using a validated questionnaire. RESULTS Median follow-up was 58 months (IQR 38-63) and mean stricture length was 1 cm (IQR 1-1.5). Of 68 cases, 56 (82.4%) were successful and 12 (17.6%) were failures requiring re-treatment. At multivariable analysis, no preoperative factor was significantly associated with recurrence. None of the preoperatively sexually active 53 patients reported postoperative erectile impairment and all were satisfied with their sexual life. The main limitation is the retrospective design. CONCLUSIONS In cases of tight bulbar stricture, the NTAVOG urethroplasty provides adequate urethral augmentation by preserving the spongiosum and avoiding postoperative sexual complications. We presented a series of patients undergone non-transecting dorsal anastomosis plus ventral oral graft urethroplasty for tight bulbar stricture. This treatment seems to be safe and with limited postoperative complications thanks to the preservation of the corpus spongiosum.
Collapse
Affiliation(s)
- Enzo Palminteri
- Center for Urethral Reconstructive Surgery, Humanitas University, Via Leoni 6, 52100, Arezzo, Italy
| | - Mirko Preto
- Center for Urethral Reconstructive Surgery, Humanitas University, Via Leoni 6, 52100, Arezzo, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicolò Lenci
- Center for Urethral Reconstructive Surgery, Humanitas University, Via Leoni 6, 52100, Arezzo, Italy
| | - Daniele Vitelli
- Department of Urology, Hesperia Hospital, CURE Group, Modena, Italy
| | - Valerio Iacovelli
- U.O. Urologia Ospedale San Carlo di Nancy Roma-GVM Care and Research, Dip. di Chirurgia Università di Roma Tor Vergata, Rome, Italy
| | - Pierluigi Bove
- U.O. Urologia Ospedale San Carlo di Nancy Roma-GVM Care and Research, Dip. di Chirurgia Università di Roma Tor Vergata, Rome, Italy
| | - Nicolò Buffi
- Urology Department, Humanitas Research Hospital, Rozzano, Italy
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, CURE Group, Modena, Italy.
| |
Collapse
|
47
|
Naud E, Rourke K. Recent Trends and Advances in Anterior Urethroplasty. Urol Clin North Am 2022; 49:371-382. [PMID: 35931430 DOI: 10.1016/j.ucl.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While patient preference often helps guide treatment decisions, poor long-term success combined with cumulative risk of repeat endoscopic treatments and the complications innately associated with urethral stricture emphasize that urethroplasty is most often the best choice for successful treatment in the long-term. This has led to the need to better refine urethroplasty techniques and optimize patient outcomes. Urethroplasty has now largely transitioned to a day-surgery procedure in the majority of centers. Some evidence suggests that avoiding urethral transection and/or avoiding overzealous urethral mobilization may lead to a reduction in post-operative sexual dysfunction. The trend toward single stage penile urethroplasty with buccal mucosal grafts likely minimizes patient morbidity without compromising urethroplasty success. For urethroplasty success to further improve particularly in patients at high risk for stricture recurrence, the synergistic potential of combining wound healing enhancing agents with evolving tissue-engineering represents an exciting future opportunity in the quest to perfect urethroplasty outcomes.
Collapse
Affiliation(s)
- Elizabeth Naud
- Division of Urology, Department of Surgery, University of Alberta, Kipnes Urology Centre, 7th Floor, Kaye Edmonton Clinic, 11400 University Avenue, Edmonton, Alberta T6G1Z1, Canada
| | - Keith Rourke
- Division of Urology, Department of Surgery, University of Alberta, Kipnes Urology Centre, 7th Floor, Kaye Edmonton Clinic, 11400 University Avenue, Edmonton, Alberta T6G1Z1, Canada.
| |
Collapse
|
48
|
Prebay ZJ, Purcell L, Chung PH. Urethral Bleeding Following Excision and Primary Anastomosis Urethroplasty. Urology 2022; 168:e9. [PMID: 35830918 DOI: 10.1016/j.urology.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Zachary J Prebay
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Leanne Purcell
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Paul H Chung
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| |
Collapse
|
49
|
Sawyer KN, Cofield SS, Selph JP. Race as a Predictor of Recurrence and Complications After Urethroplasty in Men With Urethral Stricture Disease. Urology 2022; 163:69-75. [PMID: 34852248 PMCID: PMC9142758 DOI: 10.1016/j.urology.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the role of race in surgical outcomes of and complications after urethroplasty. METHODS A single institution, retrospective review was conducted from 2011 to 2019 on male patients ≥18 years of age who underwent urethroplasty. Exclusion criteria included previous urethral cancer, lack of follow up, or revision urethroplasty. Failure of urethroplasty was defined as requiring revision surgery or recurrence on imaging or cystoscopy. Risk factors for recurrence were determined using descriptive statistics, Wilcoxon comparisons, and multivariate logistic regression. RESULTS Three hundred and seven patients were identified with 234 patients meeting inclusion criteria. 63.2% identified as White/Caucasian (CA), 32.5% Black/African American (AA), and 4.3% other race. Mean age was 49.4 years. Between CA and AA patients, there was no difference in mean age, body mass index, smoking status, prior urethroplasty, or prior dilation/DVIU. CAs were more likely to have a fossa navicularis stricture compared to AAs (P = .0094), but there were no significant differences in bulbar, penile, or posterior stricture rates (all P >.05) or length (P = .32). The overall stricture recurrence rate was 15.8% with a median of 242 days to recurrence and no significant difference by race for either outcome (P = .83, P = .64). The only predictor of stricture recurrence was prior dilation/DVIU (P = .0404, OR 2.3, 95% CI 1.0, 5.6). Overall complication rate was 17.5%, with no difference between CA and AAs rates (P = .83) or complication type (P = .62). CONCLUSION There was no significant difference in the rate of surgical failure for urethral stricture repair based on race. The only predictor of surgical failure was having a prior urethral dilation/DVIU.
Collapse
Affiliation(s)
| | - Stacey S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - John P Selph
- Department of Urology, University of Alabama School of Medicine, Birmingham, AL.
| |
Collapse
|
50
|
Luo WP, Zhao Y, Huang X, Nie J. [Risk factors for postoperative long-term hematuria in patients with benign prostatic hyperplasia]. Zhonghua Nan Ke Xue 2022; 28:422-426. [PMID: 37477481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To explore the risk factors for long-term hematuria after operation in BPH patients. METHODS We retrospectively analyzed the clinical data on 646 cases of BPH treated by transurethral surgery in Liyang People's Hospital from January 2015 to August 2020. According to the incidence of hematuria at 3 months or longer after surgery, we divided the patients into a hematuria and a non-hematuria group, recorded the related factors, and investigated the independent risk factors for long-term hematuria by univariate and multivariate analyses. RESULTS Of the 646 BPH patients, 48 were found with and 598 without hematuria after transurethral surgery. Univariate analysis showed that hypertension, diabetes mellitus, residual prostate gland, urinary tract infection, bladder neck contracture, prostate cancer, urethral calculus, urethral stricture, excessive activity and constipation were the influencing factors (P < 0.05), while multivariate logistic regression analysis revealed that hypertension (P < 0.001), diabetes mellitus (P = 0.007), residual prostate gland (P = 0.013), urinary tract infection (P < 0.001), bladder neck contracture (P = 0.032), urethral calculus (P = 0.033) and urethral stricture (P = 0.001) were independent risk factors for long-term hematuria in the BPH patients after surgery. CONCLUSION Complicated hypertension, diabetes mellitus, residual prostate gland, urinary tract infection, bladder neck contracture, urethral calculus and urethral stricture are independent risk factors for long-term hematuria in BPH patients after transurethral surgery.
Collapse
Affiliation(s)
- Wei-Ping Luo
- Department of Urology, Liyang People's Hospital, Liyang, Jiangsu 213300, China
| | - You Zhao
- Department of Urology, Liyang People's Hospital, Liyang, Jiangsu 213300, China
| | - Xin Huang
- Department of Urology, Liyang People's Hospital, Liyang, Jiangsu 213300, China
| | - Jun Nie
- Department of Urology, Liyang People's Hospital, Liyang, Jiangsu 213300, China
| |
Collapse
|