Defining a Patient-Reported Outcome Measure for Urethral Stricture Surgery

“…Treatment options for short bulbar urethral strictures include dilatation, direct visual internal urethrotomy and anastomotic urethroplasty. 3,4 Excision and end to end anastomosis (anastomotic urethroplasty) for long bulbo-membranous urethral strictures gives excellent long term results with reduced recurrence rate. 5,6 The aim of surgical reconstruction for urethral stricture is to provide an adequate calibre, compliant and stable urethra.…”

Section: Introductionmentioning

confidence: 99%

“…Good results have been achieved by different investigators with length that range from 1cm to 5cm. 4,10,11 Berger AP et al conclude that defects ranging from 0.5 to 16cm can be repaired by perineal surgical approach ranging from end to end urethroplasty for strictures less than 2cm and dorsal onlay urethroplasty, ventral buccal mucosal flaps and ventral faciocutaneous flaps for longer defects more than 2cm. overall defects up to 5cm may be successfully excised and primarily reconstructed in select young men with proximal bulbar strictures.…”

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confidence: 99%

A case series of standard surgical management of bulbo-membranous stricture

et al. 2017

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INTRODUCTIONThe urethra is traditionally divided into anterior and posterior parts. The anterior part is surrounded by the corpus spongiosum. It includes the bulbar urethra, which is enclosed by the bulbospongiosus muscle and the penile urethra that runs from the distal margin of the bulbospongiosus to the fossa navicularis and external ABSTRACT Background: Urethral stricture is an acquired permanent narrowing of the urethra impeding the flow of urine during micturition. It is one of the oldest urological diseases, and its treatment remains a challenge for urologists. Urethral stricture disease affects about 300 per 100,000 men. Most common causes are trauma and infections in developing countries and idiopathic in developed countries. Treatment options for short bulbar urethral strictures include dilatation, direct visual internal urethrotomy and anastomotic urethroplasty. Excision and end to end anastomosis (anastomotic urethroplasty) for short bulbo-membranous urethral strictures and buccal mucosal graft gives excellent long term results with reduced recurrence rate. Methods: Sixty-three patients who had undergone anastomotic urethroplasty from 2013 to 2016 at Government Medical College and Superspeciality Hospital, Nagpur, Maharashtra, India Department of Urology were included in the study. For strictures less than 2cm, excision of stricture and anastomosis done, while for stricture more than 2cm buccal mucosal grafting done over 16 F Foleys catheter. Postoperative follow up done up to 1 year. Results: The total number of patients included is 63 and study conducted between January 2013 to December 2016. End to end urethroplasty was done in 41 patients and had mean duration of surgery of about 120 minutes, while buccal mucosal grafting was done in 22 patients. Age ranges from 14 to 78 years with highest incidence of stricture was seen after 5 th decade of life, mainly due to iatrogenic causes of previous instrumentation and post TURP surgery. Strictures in younger adults are mainly as a result of trauma by fall astride injury and pelvic fractures and seen during 3 rd and 4 th decade of life. Most common length of stricture observed was 1-2cm in about 65.07% and mainly occurred due to post urethral procedures. Long strictures more than 2cm were mainly because of trauma in about 35%. Seven patients had recurrence in follow up, out of which 2 managed conservatively by repeated dilatation and 5 patients needed reoperation. Conclusions:The present results suggest that in patients with strictures too long to be excised and re-anastomosed a tension-free buccal mucosal graft provides better results. However, in patients with short strictures, in whom a completely tension-free anastomosis can be achieved, direct end-to-end anastomosis remains good option.

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“…4 The decision to use a specific reconstructive technique depends upon surgeon preference, as well as many other factors, such as length, location and etiology of stricture. Generally, the least complex procedure necessary that gives durable results is preferred.…”

Section: Introductionmentioning

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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Defining a Patient-Reported Outcome Measure for Urethral Stricture Surgery

Cited by 185 publications

References 18 publications

Editorial Comment to Two‐sided urethra‐sparing reconstruction combining dorsal preputial skin plus ventral buccal mucosa grafts for tight bulbar strictures

Editorial Comment to Two‐sided urethra‐sparing reconstruction combining dorsal preputial skin plus ventral buccal mucosa grafts for tight bulbar strictures

A case series of standard surgical management of bulbo-membranous stricture

The UREThRAL stricture score: A novel method for describing

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