Buccal Mucosa Graft Urethroplasty for Anterior Urethral Stricture Repair: Evaluation of the Impact of Stricture Location and Lichen Sclerosus on Surgical Outcome

Levine, Laurence A.; Strom, Kurt H.; Lux, Matthew M.

doi:10.1016/j.juro.2007.07.034

Cited by 109 publications

(73 citation statements)

References 20 publications

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“…In recent reports, the incidence of impotence after urethral reconstruction using various flaps or grafts ranged from 0% to 3% [10,11]. No statistical differences in IIEF-5 and SLQQ scores were found before and after this procedure in our group.…”

Section: Discussioncontrasting

confidence: 45%

Evaluation of erectile function after urethral reconstruction: a prospective study

Xie¹,

Xu²,

Xu³

et al. 2009

Asian J Androl

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We conducted a prospective study of erectile dysfunction (ED) after urethral reconstructive surgery, using the 5-item International Index of Erectile Function (IIEF-5), the Sexual Life Quality Questionnaire (SLQQ) and the Quality of Life Questionnaire (QoLQ). Between January 2003 and July 2007, 125 male patients with urethral strictures underwent urethroplasty, and pre-and post-surgery erectile function was assessed using these three questionnaires. A formula to predict the probability of ED after urethroplasty was derived. At 3 months postoperatively, there was a significant decrease in IIEF-5 (16.57 ± 7.98) and SLQQ scores (28.71 ± 14.84) compared with pre-operative scores (P < 0.05). However, the IIEF-5 scores rebounded at 6 months post-operatively (17.22 ± 8.41). Logistical regression analysis showed that the location of the urethral stricture, the recurrence of strictures and the choice of surgical technique were predictive of the post-operative occurrence of ED. This study identified the clinical risk factors for ED after urethroplasty. Posterior urethral stricture and end-to-end anastomosis were found to have a strong relationship with erectile function. The logistical model derived in this study may be applied to clinical decision algorithms for patients with urethral strictures.

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Section: Discussioncontrasting

confidence: 45%

Evaluation of erectile function after urethral reconstruction: a prospective study

Xie¹,

Xu²,

Xu³

et al. 2009

Asian J Androl

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show abstract

“…In most instances, the most severe inflammatory reaction in BXO is seen at the meatus and distal urethra, which compromises a successful stricture repair because of the recalcitrant nature of this disease. 10,19,28 Therefore, excision of the diseased urethra and one or two stage urethroplasty using extragenital tissue grafts has been advocated in patients with BXO. 10,28,29 In our present cohort, a narrow 2-3 mm of native mucosal strip was preserved on the dorsal side.…”

Section: Discussionmentioning

confidence: 99%

“…10,19,28 Therefore, excision of the diseased urethra and one or two stage urethroplasty using extragenital tissue grafts has been advocated in patients with BXO. 10,28,29 In our present cohort, a narrow 2-3 mm of native mucosal strip was preserved on the dorsal side. When the urethral plate is severely stenosed complete replacement of the diseased, fibrotic mucosa with BMG in a circular form still renders a 1-stage reconstruction possible.…”

Section: Discussionmentioning

confidence: 99%

Ventral Onlay Buccal Mucosal Graft Urethroplasty Based on Tunica Vaginalis Flap for Balanitis Xerotica Obliterans Related Urethral Strictures: The Outcome of Single- Stage Reconstruction

Singh¹

2017

jmscr

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“…Men with lichen sclerosus et atrophicus (LSA) are much more likely to have penile urethral strictures, which most definitely increases the difficulty of surgical repair. Also, Levine and colleagues 9 showed that patients undergoing urethroplasty for LSA-related strictures were more likely to develop recurrence than those patients without (5/13, 38% for LSA vs. 3/40, 7% for non-LSA). Moreover, Andrich and colleagues 10 also showed that LSA increases surgical complexity and the risk for stricture recurrence.…”

Section: (Ur)ethral Stricture (E)tiologymentioning

confidence: 99%

The UREThRAL stricture score: A novel method for describing

Wiegand

Brandes

2013

CUAJ

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Background: Urethral stricture description is not standardized. Thismakes surgical decision-making less reproducible and increasesthe difficulty of objectively analyzing urethroplasty literature. Wedeveloped a standardized system, the UREThRAL stricture score(USS), to quantify the characteristics of anterior urethral stricturedisease based on preoperative imaging and intraoperative findings.Methods: To develop the USS, we retrospectively analyzed 95consecutive patients with urethral strictures who underwent openurethroplasty by a single surgeon (SBB) at Barnes-Jewish Hospitalfrom 2009 to 2011. The USS is a numerical score based on fivecomponents of anterior urethral stricture disease that help dictateoperative decision-making: (1) (UR)ethral stricture (E)tiology; (2) (T)otal number of strictures; (3) (R)etention (luminal obliteration); (4)(A)natomic location; and (5) (L)ength. Stricture management wascategorized by increasing surgical complexity: excision/primaryanastomosis (EPA), buccal mucosal graft urethroplasty (BMG), augmented anastomotic urethroplasty (AAU), flap urethroplasty, and acombination of flaps and/or grafts. Multinomial logistic regressionanalysis was used to compare USS to surgical complexity.Results: The mean USS for EPA, BMG, AAU, flap, and combinationflaps/grafts was 5.78, 8.82, 9.23, 11.01, and 14.97, respectively.Increasing USS was significantly associated with surgical complexity(p < 0.0001).Interpretation: The USS describes the essential factors in determiningsurgical treatment selection for urethral stricture disease.The USS is a concise, easily applicable system that delineates theclinically significant features of urethral strictures. Valuable comparison of anterior urethral stricture treatments in clinical practiceand in the urological literature could be facilitated by using this novel UREThRAL stricture score.

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Buccal Mucosa Graft Urethroplasty for Anterior Urethral Stricture Repair: Evaluation of the Impact of Stricture Location and Lichen Sclerosus on Surgical Outcome

Cited by 109 publications

References 20 publications

Evaluation of erectile function after urethral reconstruction: a prospective study

Evaluation of erectile function after urethral reconstruction: a prospective study

Ventral Onlay Buccal Mucosal Graft Urethroplasty Based on Tunica Vaginalis Flap for Balanitis Xerotica Obliterans Related Urethral Strictures: The Outcome of Single- Stage Reconstruction

The UREThRAL stricture score: A novel method for describing

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