Single-stage tubular urethral reconstruction using oral grafts is an alternative to classical staged approach for selected penile urethral strictures / 亚洲男科学杂志(英文版)

Penile urethral strictures have been managed by a staged surgical approach. In selected cases, spongiofibrosis can be excised, a neo-urethral plate created using buccal mucosa graft (BMG) and tubularized during the same procedure, performing a 'two-in-one' stage approach. We aim to identify stricture factors which indicate suitability for this two-in-one stage approach. We assess surgical outcome and compare with staged reconstruction. We conducted an observational descriptive study. The data were prospectively collected from two-in-one stage and staged penile urethroplasties using BMG in a single center between 2007 and 2017. The minimum follow-up was 6 months. Outcomes were assessed clinically, radiologically, and by flow-rate analysis. Failure was defined as recurrent stricture or any subsequent surgical or endoscopic intervention. Descriptive analysis of stricture characteristics and statistical comparison was made between groups. Of 425 penile urethroplasties, 139 met the inclusion criteria: 59 two-in-one stage and 80 staged. The mean stricture length was 2.8 cm (single stage) and 4.5 cm (staged). Etiology was lichen sclerosus (LS) 52.5% (single stage) and 73.8% hypospadias related (staged). 40.7% of patients had previous failed urethroplasties in the single-stage group and 81.2% in the staged. The most common stricture locations were navicular fossa (39.0%) and distal penile urethra (59.3%) in the single-stage group and mid or proximal penile urethra (58.7%) in the staged group. Success rates were 89.8% (single stage) and 81.3% (staged). A trend toward a single-stage approach for select penile urethral strictures was noted. We conclude that a single-stage substitution penile urethroplasty using BMG as a 'two-in-one' approach is associated with excellent functional outcomes. The most suitable strictures for this approach are distal, primary, and LS-related strictures.

Single-stage tubular urethral reconstruction using oral grafts is an alternative to classical staged approach for selected penile urethral strictures / 亚洲男科学杂志(英文版)

Penile urethral strictures have been managed by a staged surgical approach. In selected cases, spongiofibrosis can be excised, a neo-urethral plate created using buccal mucosa graft (BMG) and tubularized during the same procedure, performing a "two-in-one" stage approach. We aim to identify stricture factors which indicate suitability for this two-in-one stage approach. We assess surgical outcome and compare with staged reconstruction. We conducted an observational descriptive study. The data were prospectively collected from two-in-one stage and staged penile urethroplasties using BMG in a single center between 2007 and 2017. The minimum follow-up was 6 months. Outcomes were assessed clinically, radiologically, and by flow-rate analysis. Failure was defined as recurrent stricture or any subsequent surgical or endoscopic intervention. Descriptive analysis of stricture characteristics and statistical comparison was made between groups. Of 425 penile urethroplasties, 139 met the inclusion criteria: 59 two-in-one stage and 80 staged. The mean stricture length was 2.8 cm (single stage) and 4.5 cm (staged). Etiology was lichen sclerosus (LS) 52.5% (single stage) and 73.8% hypospadias related (staged). 40.7% of patients had previous failed urethroplasties in the single-stage group and 81.2% in the staged. The most common stricture locations were navicular fossa (39.0%) and distal penile urethra (59.3%) in the single-stage group and mid or proximal penile urethra (58.7%) in the staged group. Success rates were 89.8% (single stage) and 81.3% (staged). A trend toward a single-stage approach for select penile urethral strictures was noted. We conclude that a single-stage substitution penile urethroplasty using BMG as a "two-in-one" approach is associated with excellent functional outcomes. The most suitable strictures for this approach are distal, primary, and LS-related strictures.

Comparing retrograde urethrography readings with intraoperative findings in urethral stricture

Background: Urethral strictures are relatively common in men with most patients acquiring the disease due to injury or infection. The present study was conducted to assess the accuracy of retrograde urethrography (RGU) in diagnosing urethral strictures in patients presenting with lower urinary tract symptoms.Methods: All male patients presenting with lower urinary tract symptoms and referred for retrograde urethrogram to the Department of Radiodiagnosis, Bharati Vidyapeeth Medical College and Hospital (Deemed to be University), Sangli from November 2018 till January 2019 were included. The parameters of RGU were compared with intra-operative findings as gold standard to calculate the operating characteristics of RGU.Results: The present study included 42 patients, mean age 54.9±11.2 years. Grade I urethral stricture was observed in 42.8% and 26% had grade II stricture. Bulbar stricture was the most common location. The common presenting complaints were increased frequency (50%) and dribbling micturition (40.4%). Approximately one tenth of all patients had a history of trauma. RGU was 100% sensitive and 66.7% specific in detecting strictures of less than 2 cm. Overall accuracy of RGU in detecting urethral strictures of less than 2 cm was 83.3%.Conclusions: RGU is a reliable means for establishing the diagnosis of a suspected urethral stricture and also provides accurate staging information with regard to stricture number, length, location, and coexistent urethral pathology.

Comparison study on donor site complications between buccal and lingual oral mucosal grafts harvesting for urethroplasty / 中华泌尿外科杂志

Objective To compare donor site complications of buccal or lingual mucosa grafts harvesting for substitution urethroplasty.Methods From June 2014 to December 2016,a total of 50 patients who were diagnosed anterior urethral strictures or hypospadias underwent buccal or lingual mucosa grafts urethroplasty.The mean age of the patients was 43.6 years (range 32-56 years).25 patients used buccal mucosa grafts (BMG group) for urethroplasty with the median age of 43.1 years (range 32-54 years);the other 25 patients received lingual mucosa grafts (LMG group) for urethroplasty,aged 44.2 years (range 35-56 years).Patients were evaluated for postoperative oral pain morbidity using the visual analogue pain scale (0-10) as well as an questionnaire for difficulty with eating,speech impairment,dysgeusia,tightness of the mouth.The evaluations were carried out at 3 days,2 weeks and 3 months postoperatively.Results In BMG group,the length and width of the graft was (5.24 ± 0.89) cm and (1.48 ± 0.50) cm;the graft length was (5.68 ± 0.90) cm and the width was (1.56 ± 0.51) cm in LMG group.There was no difference between the two groups.The mean followup time was (7.8 ± 1.2) months (6-12 months).The median visual analogue pain scale scores of the BMG group 3 days,2 weeks after surgery was 5.84 ±0.85,3.04 ±0.45,and the LMG group 7.20 ±0.57,4.16 ±0.62,respectively,with no statistical difference between two groups.The incidence of events with LMG group versus the BMG group were as follows:difficulty with eating (64％ vs.24％,P =0.004),speech impairment (92％ vs.56％,P=0.004) and dysgeusia (48％ vs.16％,P =0.015)at day 3.The difficulty of eating,speech impairment and dysgeusia of BMG group were lower than that of the LMG group(16％ vs.32％,P =0.031;8％ vs.40％,P =0.008;12％ vs.40％,P =0.024) two weeks after the surgery,whereas the incidence of tightness of the mouth was higher in BMG group(36％ vs.12％,P =0.04).After 3 months,36％ and 32％ of patients treated with buccal and lingual mucosa grafts urethroplasty still reported sensitivity perioral numbness(P ＞ 0.05).Conclusions Oral mucosa grafts are good for substitution urethroplasty,but also with some donor site complications.The early postoperative complications are more common in lingual mucosa graft donor site.Buccal mucosa may be used as the preferred graft for urethroplasty.Lingual mucosal graft may be considered in cases of unavailable buccal mucosa graft or the length of the graft not enough and combined graft treatment.

Exploration of the source of bacteria in the neo-urethra after anterior urethroplasty / 中华泌尿外科杂志

Objective To explore the reason that the neo-urethra infection after urethroplasty,and improve the perioperation procedures to reduce infection rate.Methods The clinical data of 62 anterior urethral stricture patients undergoing surgical treatment from July 2014 to April 2017 were analyzed.Then samples from urine,material for urethral reconstruction,urethra orifice and urethra were collected respectively.The bacterial culture,identification and pulsed field gel electrophoresis (PFGE) was performed.All the patients were males,and the mean age was 35.6 years (ranging 10-68 years).Operation methods were urethroplasty using oral mucosa in 40 cases,using penile flap in 23,using scrotal flap in 5,using penile flap combined with oral mucosa in 9,using penile flap combined with scrotal flap in 3 and using preputial flap in 1.Results The bacteria isolated from urethra orifice after operation were consistent with bacteria isolated from the neo-urethral lumen in 41 cases.There were 18 cases that shared the identical bacteria isolated from material for urethral reconstruction and neo-urethral lumen.In 7 patients,under careful isolation and identification,same bacteria were found to exist in both preoperative urethral lumen and neo-urethral lumen.Bacteria were not detected in the neo-urethral lumen in 13 cases.The bacteria isolated from urine were consistent with bacteria isolated from the neo-urethral lumen in 3 cases.Conclusions The bacteria in the neo-urethra mainly come from urethra orifice.Urine is not the main source for bacteria in neo-urethra.Perioperative intervention for sources of bacteria is an effective measure to improve the success rate of operation.

Therapeutic efficiency of short anterior urethral stricture treated with endourethral surgery combined with iridium 192 radiotherapy / 西安交通大学学报·英文版

Objective: To assess the therapeutic efficiency of short anterior urethral stricture treated with endourethral surgery combined with iridium 192 radiation therapy in order to decrease the recurrence rate after endourethral surgery. Methods: A total of 286 patients with anterior urethral stricture (stricture length ranging from 0.5 to 2.5 cm, averaging at 1.6 cm) were divided randomly into two groups after internal urethrotomy and cicatrix electrotomy. The radiation group of 173 patients was treated as soon as possible with iridium 192 radiation therapy on the stricture sections while the control group of 113 patients was not. The recurrence rate was compared between the two groups during one year's follow-up. Results: Among all the 286 successful operations, stricture recurred in 19 patients of the radiation group (recurrence rate of 10.98%) and in 62 ones of the control group (recurrence rate of 54.86%), with a significant difference (P=0.003). Conclusion: It is an effective way to prevent recurrence by treating patients as early as possible with iridium 192 radiation on the stricture sections after endourethral operation on anterior urethral stricture.

Therapeutic efficiency of short anterior urethral stricture treated with endourethral surgery combined with iridium 192 radiotherapy / 药物分析学报

Objective To assess the therapeutic efficiency of short anterior urethral stricture treated with endourethral surgery combined with iridium 192 radiation therapy in order to decrease the recurrence rate after endourethral surgery. Methods A total of 286 patients with anterior urethral stricture (stricture length ranging from 0.5 to 2.5cm, averaging at 1.6cm) were divided randomly into two groups after internal urethrotomy and cicatrix electrotomy. The radiation group of 173 patients was treated as soon as possible with iridium 192 radiation therapy on the stricture sections while the control group of 113 patients was not. The recurrence rate was compared between the two groups during one year's follow-up. Results Among all the 286 successful operations, stricture recurred in 19 patients of the radiation group (recurrence rate of 10.98%) and in 62 ones of the control group (recurrence rate of 54.86%), with a significant difference (P=0.003). Conclusion It is an effective way to prevent recurrence by treating patients as early as possible with iridium 192 radiation on the stricture sections after endourethral operation on anterior urethral stricture.

Patch Graft Urethroplasty for Anterior Urethral Strictufe / 대한비뇨기과학회지

Urethral stricture is a disorder with multiple etiologies and many recognized forms of treatment. It is often accompanied by dysuria, urinary retention, hemorrhage and sepsis. The treatment for urethral stricture most commonly has been urethral dilation. Herein we present a case of patch graft urethroplasty in a 24-year-old male patient with anterior urethral stricture.