Comprehensive Prospective Assessment of Patient-reported Outcomes Following Urethroplasty

Redmond, Elaine J.; Bekkema, Jordan; Rourke, Keith

doi:10.1016/j.urology.2020.02.034

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…Scarring of the urethral tissue is the causative process leading to the replacement of the vascular tissue of the corpus spongiosum, which leads to ischemic spongiofibrosis of the urethra [ 7 , 8 ]. Urethral strictures present a serious health condition that significantly impairs quality of life and may lead to the failure of vital organs if left untreated [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cell-Seeded Acellular Artery for Reconstruction of Long Urethral Defects in a Canine Model

Zhong

Shen

Zhao

et al. 2021

Stem Cells International

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The management of urethral stricture remains a major therapeutic challenge in clinics. Herein, we explored the feasibility of reconstructing a relatively long segment of the urethra by the cell-seeded acellular artery in a canine model. The acellular arterial matrix was obtained from the excised carotid artery of donor dogs. Autologous adipose-derived stem cells (ADSCs) from 6 male dogs were grown and seeded onto the premade acellular arterial matrix. A 3 cm long segment of the urethra was resected in 12 male dogs. Urethroplasty was performed with the acellular arterial matrix seeded with ADSCs in 6 animals and without cells in 6. Serial urethrography was performed at 1 and 3 months postoperatively. Wide urethral calibers without any signs of strictures were confirmed in all 6 animals in the experimental group. In contrast, urethral stricture was demonstrated in 3 animals in the control group. The graft was highly epithelialized and smooth in the experimental group, while graft contracture and scar formation were showed in the control group. Histologic analysis of the cell-seeded arterial matrix at 1 month confirmed the presence of multilayered urothelium and muscle. The levels of tissue formation developed over time with a progressive increase in muscle content. In contrast, extensive fibrosis and sparse smooth muscle were seen in animals treated with matrix without ADSCs. This study provides preclinical evidence that the ADSC-seeded arterial matrix can be used as a tubularized scaffold in the reconstruction of 3 cm long urethral defect in a male canine model. The ADSC-seeded arterial matrix remodels and regenerates normal-appearing urethral tissue layers over time.

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Section: Introductionmentioning

confidence: 99%

Cell-Seeded Acellular Artery for Reconstruction of Long Urethral Defects in a Canine Model

Zhong

Shen

Zhao

et al. 2021

Stem Cells International

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“…The importance of patient-reported outcome measures (PROMs) has been scrutinized over the last decade [ 2 , 3 ], culminating in the development of the Urethral Stricture Symptom and Impact Measure (USSIM) to incorporate both surgeons’ and patients’ perspective on important outcomes after urethroplasty [ 4 ]. Whereas the significance of generic quality of life tools for patients undergoing urethroplasty is controversial [ 2 , 5 ], treatment satisfaction is more or less a universally accepted surrogate of patient-centered success and has been incorporated in several recent urethroplasty outcome analyses [ 1 , 2 , 6 , 7 ]. Patient satisfaction rates after urethroplasty are fairly high and range between 78 and 87% [ 1 , 2 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Whereas the significance of generic quality of life tools for patients undergoing urethroplasty is controversial [ 2 , 5 ], treatment satisfaction is more or less a universally accepted surrogate of patient-centered success and has been incorporated in several recent urethroplasty outcome analyses [ 1 , 2 , 6 , 7 ]. Patient satisfaction rates after urethroplasty are fairly high and range between 78 and 87% [ 1 , 2 , 6 , 7 ]. However, the driving forces of dissatisfaction with the surgical outcome have not unanimously been identified and there are several potential reasons for the heterogeneity of the available evidence such as the variety of surgical techniques used or the definition of objective surgical success [ 1 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patient satisfaction rates after urethroplasty are fairly high and range between 78 and 87% [ 1 , 2 , 6 , 7 ]. However, the driving forces of dissatisfaction with the surgical outcome have not unanimously been identified and there are several potential reasons for the heterogeneity of the available evidence such as the variety of surgical techniques used or the definition of objective surgical success [ 1 , 6 , 7 ]. Experts agree on the crucial value of evaluating sexual function after urethroplasty as it has been shown that penile anatomy, erectile, and ejaculatory function may be altered by urethroplasty [ 8 , 9 ] through the dissection of bulbospongiosus and ischiocavernosus muscles and—most importantly—may affect patient-reported treatment satisfaction postoperatively [ 1 , 6 , 7 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Exploring the intersection of functional recurrence, patient-reported sexual function, and treatment satisfaction after anterior buccal mucosal graft urethroplasty

et al. 2021

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Purpose To evaluate the interplay of stricture recurrence, sexual function, and treatment satisfaction after substitution urethroplasty. Methods Observational study of men undergoing 1-stage buccal mucosal graft urethroplasty for anterior urethral stricture between 2009 and 2016. Patients were dichotomized by self-reported treatment satisfaction. Sexual function was assessed by validated and non-validated patient-reported outcome measures. Functional recurrence was defined as symptomatic need of re-intervention. Bivariate analyses, Kaplan–Meier estimates, qualitative and quantitative analyses by uni- and multivariable regression were employed to evaluate the interplay of sexual function, functional recurrence, and treatment satisfaction. Results Of 534 men with bulbar (82%), penobulbar (11%), and penile strictures (7.3%), 451 (84%) were satisfied with the surgery. There were no differences in stricture location, previous treatment, graft length, or surgical technique between satisfied and unsatisfied patients (all p ≥ 0.2). Recurrence-free survival was 85% at a median follow-up of 33 mo and decreased significantly with each Likert item towards increasing dissatisfaction (p < 0.001). Dissatisfied patients more often reported postoperative loss of rigidity, tumescence, reduced ejaculatory volume, ejaculatory pain, and reduced penile length (all p ≤ 0.042). In 83 dissatisfied men, functional recurrence (28%) and oral morbidity (20%) were the main drivers of dissatisfaction in qualitative analysis. Multivariable analyses revealed functional recurrence and impaired postoperative ejaculatory function as independent predictors of treatment dissatisfaction (all p ≤ 0.029) after adjusting for confounders. Conclusion We found an association of both functional success and sexual function with patient-reported treatment satisfaction after substitution urethroplasty. Such findings validate the clinical significance of defining the symptomatic need for re-intervention as an endpoint and underline the importance of further research evaluating sexual function before and after open urethral reconstruction.

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How Do We Assess Success After Surgical Management of Urethral Stricture Disease?

Blair

2023

Curr Bladder Dysfunct Rep

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Comprehensive Prospective Assessment of Patient-reported Outcomes Following Urethroplasty

Cited by 4 publications

References 26 publications

Cell-Seeded Acellular Artery for Reconstruction of Long Urethral Defects in a Canine Model

Cell-Seeded Acellular Artery for Reconstruction of Long Urethral Defects in a Canine Model

Exploring the intersection of functional recurrence, patient-reported sexual function, and treatment satisfaction after anterior buccal mucosal graft urethroplasty

How Do We Assess Success After Surgical Management of Urethral Stricture Disease?

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