Cost-effective Strategies for the Management and Treatment of Urethral Stricture Disease

Osterberg, E. Charles; Murphy, G.P.; Harris, Catherine R.; Breyer, Benjamin N.

doi:10.1016/j.ucl.2016.08.002

Cited by 17 publications

(12 citation statements)

References 28 publications

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“…[6][7][8][9] Despite the low rate of cure, endoscopic urethral dilatation and optical urethrotomy remain by far the most commonly performed procedures for urethral stricture disease. [14][15][16] These guidelines are based on the premise that urethroplasty is the definitive treatment for urethral stricture with 85-95% long-term stricture free rates in general terms, 6 is cost effective, 17,18 and that intermittent stricture dilatation following initial endoscopic management is a palliative treatment approach. [14][15][16] These guidelines are based on the premise that urethroplasty is the definitive treatment for urethral stricture with 85-95% long-term stricture free rates in general terms, 6 is cost effective, 17,18 and that intermittent stricture dilatation following initial endoscopic management is a palliative treatment approach.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13] Earlier definitive urethral reconstruction has been advocated in recent years with establishment of guidelines by the Société Internationale d'Urologie and the American Urological Association. [14][15][16] These guidelines are based on the premise that urethroplasty is the definitive treatment for urethral stricture with 85-95% long-term stricture free rates in general terms, 6 is cost effective, 17,18 and that intermittent stricture dilatation following initial endoscopic management is a palliative treatment approach. 15 Despite its advantages, studies suggest an underutilization of urethroplasty in the management of patients with urethral stricture disease.…”

Section: Introductionmentioning

confidence: 99%

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Male urethral stricture disease in a regional centre: 10 years of experience

Hong

Murugappan

Norton

et al. 2019

ANZ Journal of Surgery

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Background: Male urethral stricture disease is a challenging condition with a propensity for recurrence following endoscopic management. In recent years, earlier definitive urethral reconstruction has been advocated through international guidelines, prompted by series suggesting the underutilization of urethroplasty at rates of 0.6-0.8%. However, little local data exists to characterize our urethral stricture patients and we aimed to characterize the management of patients with urethral stricture disease presenting over a 10-year period to a single regional centre. Methods: Patients with urethral stricture disease and admitted to a regional health service were identified. Retrospective chart review was undertaken for patients detailing basic demographics, stricture characteristics, clinical management and follow up. Results: We identified 360 patients with median age 69 years (interquartile range 56-77). A total of 191 (53%) presented with lower urinary tract symptoms, 122 (34%) urethral strictures were incidental, and 13% presented in urinary retention. Bulbar urethral strictures were the commonest strictures at 40% with most being spontaneous or idiopathic (67%). A total of 339 patients had treatment during their first admission, 48% of patients had subsequent treatment on a second episode, and over 20% had a third or subsequent treatment. Only 21 (5.8%) underwent urethroplasty. Urethral dilatation and optical urethrotomy were most commonly performed (54%). With follow up 19 months (interquartile range 2-56), 205 (57%) were voiding, 38 (11%) were performing intermittent catheterization, and 59 were catheterized permanently. Conclusion: Definitive urethral reconstruction appears underutilized in our cohort of patients. A high proportion of incidentally presenting urethral strictures emphasizes the importance of wider education to optimize patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Male urethral stricture disease in a regional centre: 10 years of experience

Hong

Murugappan

Norton

et al. 2019

ANZ Journal of Surgery

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“…The success rate of DVIU is poor 16,17 and contro-versial even for routine urethral stricture management. [18][19][20] Urethral strictures after AUS erosion are often associated with a segmental gap in the urethra and intense fibrosis in the area of the urethral injury. In this respect, the findings are very similar to severe straddle trauma with transection of the urethra.…”

Section: Commentmentioning

confidence: 99%

Outcomes of Urethroplasty to Treat Urethral Strictures Arising From Artificial Urinary Sphincter Erosions and Rates of Subsequent Device Replacement

Keihani

Chandrapal

Peterson

et al. 2017

Urology

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“…It has an estimated prevalence rate of 0.6%. [1][2][3] USD is a common and challenging problem for urologists. 4 Many valid option modalities are accessible for the management of USD, such as urethral dilatation (UD), internal urethrotomy (IU), urethral stent placement, and urethroplasty.…”

Section: Introductionmentioning

confidence: 99%

Experience of 138 Transurethral Urethrotomy With Holmium:YAG Laser

et al. 2019

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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.

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Cost-effective Strategies for the Management and Treatment of Urethral Stricture Disease

Cited by 17 publications

References 28 publications

Male urethral stricture disease in a regional centre: 10 years of experience

Male urethral stricture disease in a regional centre: 10 years of experience

Outcomes of Urethroplasty to Treat Urethral Strictures Arising From Artificial Urinary Sphincter Erosions and Rates of Subsequent Device Replacement

Experience of 138 Transurethral Urethrotomy With Holmium:YAG Laser

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