Is there an association between a high monocyte/high-density lipoprotein cholesterol ratio and recurrence of urethral stricture after internal urethrotomy?

INTRODUCTION: Internal urethrotomy (IU) has been the most commonly used procedure for the treatment of urethral strictures (US) since it was described by Scahse in 1974. Although simple to perform and associated with a short recovery time, the main disadvantage is the high recurrence rate of stenosis. At present, there are no markers available for the prediction of recurrence after IU. The aim of this study was to evaluate the correlation between MHR and recurrence rates. METHODS: The data of a total of 250 male patients who underwent IU for the first time for bulbar urethral stricture less than 2cm in our hospital between January 2011 and January 2019 were retrospectively analysed. The MHR was calculated as the ratio of monocytes to HDL-C. RESULTS: In all, 78 patients experienced a recurrence while the remaining 177 did not. The stricture recurrence rate was recorded as 31.2% at the 3-year follow-up. There was a statistically significant difference in stricture length and MHR (P=0.015 and 0.001 respectively). MHR was high in the recurrent group. As a result of the Chi-square test, the positive predictive values (PPV) and negative predictive values (NPV) were 65.3% and 89.7%, respectively. ROC analysis was used to determine the optimal cut-off value. The cut-off value was found to be 1.72. CONCLUSION: In our opinion, a high MHR may indicate the presence of immune inflammation and it can be used as a prognostic factor for stricture recurrence after IU.

Investigation of risk factors in the development of recurrent urethral stricture after internal urethrotomy.

BACKGROUND: Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen. Although endoscopic methods are mostly used in its treatment, it has high recurrence rates. Therefore, open urethroplasty is recommended after unsuccessful endoscopic treatments. AIM: To investigate the risk factors associated with urethral stricture recurrence. METHODS: The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed. Demographic data, comorbidities, preoperative haemogram, and biochemical values obtained from peripheral blood and operative data were recorded. Patients were divided into two groups in terms of recurrence development; recurrence and non-recurrence. Initially recorded data were compared between the two groups. RESULTS: A total of 303 patients were included in the study. The mean age of the patients was 66.6 ± 13.6 years. The mean duration of recurrence development was 9.63 ± 9.84 (min-max: 1-39) months in the recurrence group. Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15 ± 24.07 (min-max: 12-84) months. In the comparison of both groups, the presence of diabetes mellitus (DM), hypertension (HT), and multiple comorbidities were significantly higher in the recurrence (+) group (P = 0.038, P = 0.012, P = 0.013). Blood group, postoperative use of non-steroidal anti-inflammatory drugs, preoperative cystostomy, cause of stricture, iatrogenic cause of stricture, location and length of stricture, indwelling urinary cathater size and day of catheter removal did not differ between the two groups. No statistically significant difference was observed between the two groups in terms of age, uroflowmetric maximum flow rate value, hemogram parameters, aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting blood sugar, creatinine, glomerular filtration rate, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, monocyte-lymphocyte ratio and AST/ALT ratios. CONCLUSION: In patients with urethral stricture recurrence, only the frequency of DM and HT was high, while inflammation marker levels and stricture-related parameters were similar between the groups.

Acute Kidney Injury in a Previously Healthy 56-Year-Old Male Following a Direct Visual Internal Urethrotomy of a Bulbar Stricture.

Acute kidney injury (AKI) is a frequent finding in acutely ill and hospitalized patients arising from various etiologies. Anuric AKI, a more pronounced form of AKI in which less than 100 cc of urine is produced per day, is most frequently encountered in hospitalized, septic, and post-surgical patients, often secondary to shock or bilateral urinary tract obstruction. The development of anuric AKI in previously healthy patients after outpatient urological procedures presents a unique challenge to physicians, as many outpatient procedures require the routine perioperative administration of multiple nephrotoxic medications. Further complicating this clinical scenario, some surgical procedures that intrinsically involve iatrogenic injury to the kidney, ureter, bladder, or nearby organ can rarely lead to a phenomenon known as reflex anuria, an anuric state typically associated with AKI. Here, we report an unusual case of a previously healthy 56-year-old male who developed anuric AKI two days after direct visual internal urethrotomy (DVIU) for the treatment of a bulbar stricture. Non-contrast CT revealed no signs of an obstructive process, and laboratory findings supported an intrarenal cause of AKI. Consideration was given to non-steroidal anti-inflammatory drugs (NSAID)-induced nephrotoxicity, gentamicin-associated acute tubular necrosis, and propofol infusion syndrome, in addition to their potential synergistic effects. We also explore this as the first reported case of reflex anuria occurring at the level of the bulbar urethra, as most cases have involved direct injury to the kidney or ureter. Over the course of 10 days, our patient responded well to treatment with supportive measures and dialysis, with his vomiting, electrolyte abnormalities, renal state, and anuria eventually improving.

Patient reported outcomes of intermittent self-dilatation after direct vision internal urethrotomy.

PURPOSE: Long-term results on quality of life (QoL) as well as clinical outcomes of intermittent self-dilatation (ISD) of the urethra after direct visual internal urethrotomy (DVIU) are scarce. The aim of this study was to prospectively evaluate patient reported outcomes (PROs) on voiding symptoms and QoL in a large cohort of urethral stricture patients performing ISD. METHODS: We identified a total of 121 patients who performed ISD following DVIU between 2008 and 2013. Baseline assessment was conducted for each patient before ISD was started. Follow-up visits were scheduled in 6-month intervals. Each assessment included the following questionnaires: International prostate symptom score (IPSS), IPSS quality of life index (IPSS-QoL), patient global impression of severity (PGI-S), and patient global impression of improvement (PGI-I). Additional parameters were maximum urinary flow rate (Qmax ), postvoid residual urine, rate of complications, and stricture recurrence. Linear mixed models were used to examine the change over the course of the follow-up visits to the baseline. RESULTS: The median age of the patients was 58 years (interquartile range [IQR]: 43-70). The median follow-up was 17 months (IQR: 7-30). Mean change from baseline IPSS was -6.1, -5.9, -4.2, and -4.8 points at 6, 24, 36, and 48 months. Mean change from baseline IPSS-QoL was -1.3, -1.4, -1.6, and -1.8 points, respectively. Mean PGI-I was 1.7 points at 6, 1.9 points at 24, 1.9 points at 36, and 2.2 points at 48 months after ISD initiation. Mean change of Qmax ranged from 1.7 at 6 to 2.2 mL/s at 48 months. The median complication rate was 3.3% per 6-month ISD interval. Overall, 11 patients developed stricture recurrence (9%). CONCLUSION: ISD after DVIU had no negative impact on patients' QoL (IPSS-QoL, PGI-I, PGI-S). Urodynamic parameters remained stable for up to 48 months with low complications and an acceptable stricture recurrence rate.

Is testosterone deficiency a predictive factor for recurrence of urethral stricture?

BACKGROUND: Testosterone plays a vital role in maintaining tissue homeostasis, and testosterone deficiency may potentially influence the likelihood of urethral stricture recurrence. OBJECTIVES: To evaluate the prognostic value of testosterone levels in the recurrence after direct visual internal urethrotomy in primary short segment bulbar urethral strictures and its clinical reflections. MATERIALS AND METHODS: A total of 723 patients who underwent direct vision internal urethrotomy between January 2000 and October 2022 were retrospectively analyzed. After implying exclusion criteria, 116 patients with available data were enrolled. Patients were divided into two groups as recurrence and no recurrence. Age, stricture length, etiology, time of recurrence, diagnosis of previous diabetes mellitus, hypertension, smoking, body mass index, and total testosterone levels were recorded. Free testosterone and bioavailable testosterone values were calculated using total testosterone, albumin, and sex hormone binding globulin values. Hypogonadism was considered as a total testosterone level less than 300 ng/dL. Demographic characteristics and total testosterone, free testosterone, and bioavailable testosterone levels were compared between the two groups for statistical significance. The recurrence rates of patients with and without hypogonadism were compared. RESULTS: Recurrence was observed in 41.4% of the cases (n = 48). There was no statistically significant difference between the groups in terms of age, body mass index values, diabetes mellitus, hypertension, smoking status, presence of hypogonadism, and etiology (p = 0.745, 0.863, 0.621, 0.622, 0.168, 0.051, and 0.232). In terms of total testosterone levels and bioavailable testosterone levels, the recurrence group had significantly lower values (p = 0.018 and 0.04). There was no significant difference between the two groups in terms of stricture length (p = 0.071). Sixteen of 28 patients with hypogonadism had recurrence, whereas 32 of 88 patients without hypogonadism had recurrence (p = 0.051). DISCUSSION: Testosterone levels have potential to predict recurrence in primary short-segment bulbar urethral strictures. This study represents the inaugural analysis of the impact of testosterone deficiency on recurrence within the cohort of patients with primary short-segment bulbar urethral strictures. CONCLUSION: Testosterone levels and ratios may serve as predictive factors for identifying recurrent cases in primary short-segment bulbar strictures. For patients at a higher risk of recurrence, urethroplasty may be considered as an initial treatment option, even in cases of primary and short-segment strictures.

Short-term recurrence rate of male urethral stricture and its predictors after treatment with optical internal urethrotomy: Prospective Cohort Study at a tertiary center in Ethiopia.

Background: Although optical internal urethrotomy is popular among the urologists due to its simplicity and safety, urethroplasty is considered the gold standard treatment for urethral strictures. This study aims to determine the 1-year recurrence rate of urethral strictures after optical urethrotomy and identify predictors of recurrence in a tertiary center in Ethiopia. Methods: A prospective observational cohort study was conducted on 80 male patients who underwent optical urethrotomy from November 2019 to August 2020 in a tertiary center in Ethiopia. Logistic regression was used to analyze the association between dependent and independent variables, with a P-value of <0.05 considered statistically significant. Results: The mean and median age (±SD) of patients at the time of the procedure were 54.76 (±14.74) and 58 years with a range [20-78], respectively. Urethral discharge was the most common etiology identified in 39 (48.75%) of patients. Eleven (13.75%) patients had no identifiable etiology for their urethral stricture disease.The majority of patients presented with at least one voiding lower urinary tract symptoms.Sixty-eight (85%) patients out of the total had a single stricture and 12 (15%) had multiple strictures. The location of the stricture was in the bulbar urethra on cystourethrography in 83% of the patients. The 1-year recurrence rate of urethral stricture after optical urethrotomy was 35% in our study.The number of strictures and the presence of hypertension were independent predictors of recurrence of urethral stricture within 1-year after treatment with optical urethrotomy (AOR=15.35, 95% CI: 2.92-80.61, P=0.00; AOR=19.47, 95% CI: 2.11-178.98, P=0.01, respectively). Conclusions: Our study identified that multiple strictures, and the presence of hypertension are associated with an increased recurrence rate in the first postoperative year.

Efficacy of Mitomycin C Combined with Direct Vision Internal Urethrotomy for Urethral Strictures: A Systematic Review and Meta-Analysis.

BACKGROUND: The high recurrence of a urethral stricture after direct vision internal urethrotomy (DVIU) has been a problem for years. Mitomycin C (MMC) is an excellent antifibrosis antigen that has been used in many fields, but its effect on a urethral stricture remains controversial. The purpose of this review was to investigate the effectiveness of MMC in reducing the recurrence rate of a urethral stricture after the first urethrotomy. METHODS: Common databases were searched for publications prior to November 30, 2020. Randomized controlled and cohort trials were all included. Recurrence and success rates after the first urethrotomy of the posterior urethra were the main outcomes. Revman 5.3 was used for statistical analysis. Two evaluation systems, the Cochrane risk of bias tool and the Newcastle Ottawa Scale, were used to examine the risk of bias for RCTs and all studies. The quality of evidence was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation standard. RESULTS: Sixteen trials were included, the reporting quality of which was generally poor, and the evidence level was very low to moderate. The addition of MMC could significantly reduce the recurrence rate of urethral strictures (risk ratio [RR] = 0.42; 95% confidence interval [CI]: 0.26, 0.67; p = 0.0002; 9 trials; 550 participants). The results of the subgroup analysis suggested that the effect of MMC combined with DVIU was significant in short (≤2 cm) anterior urethral strictures (RR = 0.39; 95% CI: 0.20, 0.78; p = 0.008), >12-month follow-up (RR = 0.45; 95% CI: 0.26, 0.76; p = 0.003). It also increased the success rate of the first urethrotomy procedure for posterior urethral contracture (RR = 0.74; 95% CI: 0.65, 0.84; p < 0.00001; 7 trials; 342 participants). Low-dose local injection of MMC was the most commonly used method. CONCLUSION: MMC combined with DVIU is a promising way to reduce the long-term recurrence rate of a short-segment anterior urethral stricture. It also increases the success rate of the first urethrotomy of the posterior urethra. However, more high-quality randomized controlled trials are needed.

Optimizing decision-making after ventral onlay buccal mucosa graft urethroplasty failure.

OBJECTIVES: To evaluate factors predicting recurrence after treatment and to assess the best rescue option for patients failing buccal mucosa graft (BMG) urethroplasty. MATERIALS AND METHODS: We evaluated the data from 575 patients treated with ventral onlay BMG urethroplasty. Multivariable Cox regression analysis was performed to identify predictors of BMG urethroplasty failure, and their effect on failure risk was estimated using the Kaplan-Meier method and compared using log-rank tests. Then, for those patients who underwent a rescue treatment, namely, direct visual internal urethrotomy (DVIU) vs open urethroplasty, we assessed the probability of success after retreatment using the Kaplan-Meier method and regression tree analyses. RESULTS: On multivariable Cox regression analysis, only stricture length ≥5 cm (hazard ratio 3.46, 95% confidence interval 1.50-7.94; P = 0.003) was a predictor of failure. A total of 103 patients had at least one re-intervention. Notably, 12-month success rates after first rescue DVIU, second rescue DVIU, third rescue DVIU, and fourth rescue DVIU were 66.3%, 62.5%, 37.5% and 25%, respectively. Conversely, for those patients who underwent open urethroplasty retreatment, success rates at 12 months were 83.3%, 79%, 92.3% and 75% after BMG ventral onlay, first rescue DVIU, second rescue DVIU and third rescue DVIU, respectively. These data were confirmed in regression tree analyses. CONCLUSION: Ventral BMG urethroplasty fails in approximately one out of five patients. Despite DVIU as a rescue treatment being a good option, its success rate becomes lower as the number of DVIU treatments performed increases. Conversely, open urethroplasty improves patient outcomes in almost three out of four patients, even in the case of previous failed DVIU treatments for stricture recurrence.

Interventional urethral balloon dilatation before endoscopic visual internal urethrotomy for post-traumatic bulbous urethral stricture: A case report.

BACKGROUND: While several treatment options are available for pediatric urethral strictures, the appropriate treatment must be based on several factors. Although endoscopic visual internal urethrotomy (EVIU) could be a first-line treatment option for short pediatric urethral strictures, it is not feasible if the urethroscope cannot pass through the stricture point. Herein, we present a pediatric case of severe post-traumatic bulbous urethral stricture that was successfully treated by EVIU after securing the urethral route via interventional balloon dilatation. CASE SUMMARY: A 12-year-old boy presented at our outpatient clinic with the inability to urinate. He had sustained a straddle injury three months prior. The post-void residual urine volume was 644 mL, and retrograde urethrography confirmed severe stricture of the bulbous urethra. EVIU was planned; however, the first attempt to treat the stricture failed because the urethroscope could not pass through the stricture point. The urethral route was subsequently secured via balloon dilatation of the stricture, which was performed in collaboration with specialists from the department of interventional radiology. The urethroscope was then able to pass, and the repeat EVIU was successful. CONCLUSION: Interventional urethral balloon dilatation before EVIU may help secure the urethral route in the treatment of pediatric urethral strictures.

The efficacy and safety of mitomycin C intra urethral injection to prevent recurrent urethral stricture: A systematic review and meta-analysis.

Objectives: Direct Vision Internal Urethrotomy (DVIU) is regarded as the most popular and frequently used minimal invasive approach for treating urethral stricture. However, the application of this procedure is limited due to the high recurrence rate. Recent trials have the benefit of mitomycin C as adjuvant therapy to reduce the stricture recurrence in DVIU procedures. In this meta-analysis, we aim to determine the efficacy of mitomycin C as adjuvant therapy for DVIU. Methods: A systematic literature search was carried out from Embase, ScienceDirect, and PubMed published up to September 2021. Relevant Randomized Controlled Trials (RCTs) were screened using our eligibility criteria. The quality assessment of the RCT was assessed using Cochrane RoB 2. The outcome was measured as an Odds Ratio (OR) with 95% Confidence Intervals (CIs). Statistical analyses were performed using RevMan 5.4. Results: We included four RCTs in the meta-analysis, with a total of 392 patients with urethral strictures undergoing DVIU. The pooled analysis showed a significantly lower recurrence rate in patients undergoing DVIU with additional treatment of mitomycin C compared to the control group (OR 0.27, 95% CI 0.16-0.45, p < 0.0001). Conclusion: Our findings highlight the benefit of adjuvant treatment with mitomycin C to reduce the incidence of urethral stricture recurrence after DVIU procedures.

Outcomes of Vesicourethral Anastomotic Stenosis and Bladder Neck Contracture With Direct Visual Internal Urethrotomy With Mitomycin-C After Prostate Cancer Treatment.

OBJECTIVE: To examine the use of Direct Visual Internal Urethrotomy with Mitomycin-C (DVIU-MMC) for bladder neck contracture and vesicourethral anastomotic stenosis in men who have undergone treatment for prostate cancer with radical prostatectomy and/or radiation therapy. METHODS: Retrospective chart review of patients at a tertiary care center who underwent DVIU-MMC for recurrent bladder neck contracture/vesicourethral anastomotic stenosis between 2012 and 2020. Patients with complete urethral obliteration, prior bladder neck reconstruction, or less than 3 months of follow-up were excluded. Patients were sorted into three groups based on prostate cancer treatment history: radical prostatectomy (RP), RP with subsequent external beam radiation therapy (RP-EBRT), and radiation therapy (RT). RESULTS: Fifty-one patients with a median follow up of 32 months were included. Twenty-nine percent had pre-operative suprapubic tube (SPT), Foley, or required clean intermittent catheterization. Overall success after initial DVIU-MMC was 45%. In all patients with up to four procedures, cumulative overall success was 84%. There was no significant difference in relative success rates between groups. However, the interval to recurrence after initial DVIU-MMC was shortest for RP-EBRT group (P = .018). Three patients required SPT, all were in the RP-EBRT group. There was no statistical difference in recurrence after any number of procedures between patients in radiation (RP-EBRT and RT) and non-radiation (RP) groups. CONCLUSION: There was no significant difference in success rates between patients who had undergone RP-EBRT, RT, or RP. However, our data suggests that RP-EBRT patients experience poorer outcomes given that their interval to recurrence was more rapid and all patients requiring SPT placement were in this group.

Holmium: YAG Versus Cold Knife Internal Urethrotomy in the Management of Short Urethral Strictures: A Randomized Controlled Trial.

Introduction: our study aimed to assess the safety and efficacy of Holmium: YAG laser internal urethrotomy compared to the cold knife internal urethrotomy. Methods: Eighty adult male patients presented with a urethral stricture less than 1.5 cm were included in our study; they were randomly allocated into 2 groups representing Holmium and cold knife internal urethrotomy. A careful evaluation with ascending cystourethrogram and uroflowmetry were done on all patients, and they were followed up for 1 year with uroflowmetry. Results: Each group included 40 patients sharing the same demographic data. The most common cause of a urethral stricture in both groups was iatrogenic injury. The mean operative time of the cold knife urethrotomy procedure was 10.98 ± 2.40 minutes compared to 15.43 ± 2.48 minutes in the holmium laser urethrotomy group with a highly significant difference. The results showed success rates of 90% and 80% for the holmium laser and cold knife internal urethrotomy groups respectively. The perioperative complication according to the Clavien-Dindo classification, showed no statistically significant difference in grade 1 and 2 complications. A recurrence rate with the need for redo surgery representing grade 3B complication was seen in 4 cases in the Holmium group compared to 8 cases in the cold knife group with a statistically significant difference. Conclusion: Both Holmium Laser and cold knife internal urethrotomy are an effective surgical option for the treatment of a urethral stricture less than 1.5 cm with a promising outcome after 1-year follow-up with a better success rate using the Holmium laser.

[Evaluation of the effectiveness of surgical treatment of recurrent urethral stricture].

INTRODUCTION: The recurrent course of the disease stricture is a complex problem for both the patient and the operating surgeon and requires an integrated approach to treatment only in expert centers. PURPOSE OF THE STUDY: To assess the effectiveness of methods of surgical treatment of recurrent urethral strictures. MATERIALS AND METHODS: At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, an analysis of the results of surgical treatment of patients with recurrent urethral stricture from 2012 to 2020 was carried out. This work included patients who underwent surgical treatment for recurrent urethral stricture. A total of 120 men were involved in the work. The median length of the stricture was (min-max) - 2 (0.5-16 cm). In 95 (79.1%) patients, stricture of the bulbous urethra, in 15 (12.5%) - in the penile urethra, in 2 (1.7%) patients had panurethral stricture, in 6 (5.0%) - membranous urethra and in 2 (1.7%) - meatus. All patients were divided into two groups: with recurrent urethral stricture after primary DVIU (group I, n=77) and recurrent urethral stricture after primary urethroplasty (group II, n=43). Depending on the method of surgical treatment of recurrent urethral stricture, patients in group I were divided into 4 subgroups. Repeated DVIU + 3 months Autocatheterization - 16 (20.8%) patients; End-to-end urethroplasty - 37 (48.1%) patients; one-stage urethroplasty with a buccal graft or skin graft - 22 (28.6%) patients; multistage urethroplasty or perineostomy - 2 (2.5%) patients. Group II was also divided into 4 subgroups. DVIU - 17 (39.5%) patients; end-to-end urethroplasty - 6 (13.9%) patients; one-stage urethroplasty with a buccal graft or skin graft - 9 (20.9%) patients; multistage urethroplasty - 11 (16.7%) patients. Median Qmax - 4.68 ml/sec. Preoperative cystostomy was observed in 31 (25.8%) patients. RESULTS: The median follow-up was 24 months (range 12 to 76 months). Depending on the method of surgical treatment of recurrent urethral stricture, the effectiveness of DVIU according to strict indications was 75.7%. End-to-end urethroplasty showed an efficiency of -88,4%. One-stage augmentation urethroplasty had an efficiency of -77,4%, and multi-stage urethroplasty showed an efficiency of 84.6%. The IPSS value for the observation period 2 years was 2.6+/-0.9 points. The average value of Qmax at the time of observation was 19.4+/-7.1 ml/sec. The effectiveness of the treatment was 82%. During the follow-up period, a relapse was noted in 22 (18%) patients. The overall effectiveness of the treatment of recurrent urethral stricture, taking into account the treatment of recurrent cases of disease recurrence, was 97.5%. CONCLUSIONS: Urethroplasty is the treatment of choice for recurrent urethral strictures, which has been shown to be more effective than DVIU. However, the results of urethroplasty for recurrent strictures are worse than for primary strictures.

Is pre-referral management of anterior urethral strictures prior to urethroplasty appropriate?

OBJECTIVES: To evaluate whether the management of anterior urethral strictures prior to definitive urethroplasty is appropriate. METHODS: Of a total of 419 men diagnosed with anterior urethral strictures at hospitals across Japan and thereafter referred to our institution for definitive urethroplasty between 2004 and 2019, the medical records of 371, for whom data on stricture characteristics at the initial diagnosis and pre-referral management were available, were retrospectively reviewed. A pre-referral single transurethral procedure, such as direct vision internal urethrotomy or urethral dilation, was considered appropriate only for favorable stricture, defined as a single nontraumatic untreated bulbar urethral stricture ≤2 cm in size, and repeat transurethral procedures were considered inappropriate in any circumstances. The association between the appropriateness of the pre-referral management strategy and patient and clinical characteristics was analyzed. RESULTS: A total of 242 patients (65.2%) had a pre-referral history of at least one transurethral procedure, and performing the procedure was considered inappropriate for 221 patients (59.6%). On multivariate logistic regression analysis, location of the patient's residence far from our institution (outside of the Kanto area; odds ratio 3.35, 95% confidence interval 1.86-6.04; P < 0.0001), voiding with intermittent dilation (odds ratio 2.38, 95% confidence interval 1.38-4.12; P = 0.002), iatrogenic stricture (odds ratio 11.18, 95% confidence interval 5.30-23.61; P < 0.0001), and stricture longer than 20 mm (odds ratio 3.05, 95% confidence interval 1.47-6.38; P = 0.003) were the independent predictors of inappropriate use of transurethral procedures. CONCLUSIONS: Transurethral procedures are often inappropriately used. There is a clear need to promote appropriate management strategies for urethral strictures among general urologists.

Comparative study between Amplatz renal dilator vs visual internal urethrotomy (cold knife) for the treatment of male urethral stricture.

AIM: The study aimed to assess and compare urethral stricture (US) management outcomes, efficiency, and complications, treated by either Amplatz renal dilator or visual internal urethrotomy (VIU). PATIENTS AND METHODS: This prospective comparative study was carried out on 88 male patients with stricture urethra. All patients have performed a physical examination, ascending and micturition urethrography, urodynamic, and pelvic ultrasound. The patients were randomized divided into group 1 (Amplatz group) 44 patients treated with Amplatz dilator, and group 2 (VIU group) 44 patients treated with a cold knife. Patients were followed up at 15 days,3,6, and 12 months after the procedure. RESULT: The mean age was 41.2 (22-73) years. The mean stricture length in group 1 and group 2 was 1.01 ± 0.40 and 1.04 ± 0.30, respectively (p = 0.421). The average IPSS score at baseline for group 1 and group 2 was 21.2 and 21.9 points, respectively. During the 12 months follow-up, IPSS improved, with average scores of 16.1 and 17.3 for group 1 and group 2, respectively (p > 0.05). The mean values of (Q max) between group 1 and group 2 at baseline, day 15, day 90 and 180 days showed no significant difference but at 12 months, (Q max) showed a higher significant difference in group 1 than group 2 (p = 0.003). The post-void residual (PVR) displayed a significant decline in both groups from baseline. After 1 year, PVR showed that group 2 was a little higher than group 1 (no significance) compared to baseline The procedures were found effective without recurrence in all patients (both groups) during the 12 months (Q max > 15m/s). However, group 2 reported (11.4%) intra-operative bleeding, and (6.8%) extravasations. CONCLUSION: The guided urethral dilation and internal urethrotomy are safe, short time procedures, and offer satisfactory results with the advance to VIUD in Qmax at 12 months. No recurrence was documented in both groups after 12 months. VIU reported 18% intraoperative complication.

Endoscopic Management of Urethral Stricture Disease and Bladder Neck Contractures.

This section aims to review general principles of endoscopic management of urethral stricture disease and posterior urethral stenosis, with a special focus on the indications for treatment and technical aspects of urethral dilation and internal incision.

Focus on Internal Urethrotomy as Primary Treatment for Untreated Bulbar Urethral Strictures: Results from a Multivariable Analysis.

BACKGROUND: The use of internal urethrotomy for treatment of urethral stricture remains a controversial topic in urology. OBJECTIVE: To investigate outcomes and predictors of failure for internal urethrotomy as primary treatment for untreated bulbar urethral strictures. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective analysis of patients who underwent internal urethrotomy. Patients with bulbar urethral stricture who did not receive any previous treatment were included. Patients with traumatic, penile or posterior urethral strictures, lichen sclerosus, failed hypospadias repair, or stricture length >4cm were excluded. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was treatment failure. Kaplan-Meyer plots were used to depict treatment failure-free survival. Univariate and multivariable Cox regression analyses were used to test the association between predictors (age, body mass index, diabetes, history of smoking, etiology, stenosis type and length, preoperative maximum flow [pQmax]) and treatment failure. RESULTS AND LIMITATIONS: Overall, 136 patients were included. The median stricture length was 2cm. Median follow-up was 55 mo. At 5-yr follow-up the failure-free survival rate was 57%. On univariate analysis, diabetes, nonidiopathic etiology, stricture length of 3-4cm, and pQmax were significantly associated with treatment failure. These predictors were included in a multivariable analysis, in which pQmax was the only significant predictor of treatment failure. CONCLUSIONS: Failure of internal urethrotomy for untreated bulbar urethral strictures greatly depends on pQmax flow at uroflowmetry. Patients with pQmax >8ml/s have a high probability of success, while patients with pQmax <5ml/s have a low probability of success. PATIENT SUMMARY: The use of internal urethrotomy in patients with an untreated bulbar urethral stricture should only be considered in selected cases.

A Novel Method of Local Anesthesia for Optical Internal Urethrotomy.

Direct vision internal urethrotomy (DVIU) is the treatment of choice for short anterior urethral strictures. It is performed under spinal or general anesthesia although it can also be done under local anesthesia. We describe a novel method of local anesthesia for internal urethrotomy. The technique described is feasible in morbid patients who are deemed unfit for spinal or general anesthesia and achieves good analgesia.

Experience of 138 Transurethral Urethrotomy With Holmium:YAG Laser.

Introduction: Many valid option modalities are available for the management of urethral stricture disease (USD), such as internal urethrotomy which has the success rates of 33%-60%. The aim of this study was to assess the outcome of holmium: YAG (Ho: YAG) laser urethrotomy (HLU). Methods: One hundred thirty-eight patients with urethral stricture with the mean age of 48±3.03 years old treated by HLU from March 2011 to August 2017. The main purpose of this investigation was to evaluate mean operation time, stricture recurrence rate and post-operation Qmax and complications of transurethral HLU. Results: The most common cause of USD was trauma in 82 (59.4%) patients. Mean laser operation time, mean hospital stay and mean postoperative duration of catheterization were 23.08 ± 9.1 minutes, 19.02 ± 10.7 hours and 10.3 ± 1.05 days respectively. The mean Qmax was 8.3 ± 2.07 mL/s before surgery and 16 ±3.1 mL/s afterward. At the end of 12 months follow-up, a total of 37 (26.8%) patients developed recurrence of the stricture. Patients with posterior, longer urethral strictures and previous history of interventions have more recurrence rate of the stricture. Conclusion: HLU is minimally invasive and seems to be an effective and safe management option for primary, short, urethral strictures. The hospital stay is remarkably short and complications are negligible.