Direct visual internal urethrotomy for isolated, post-urethroplasty strictures: a retrospective analysis

Brown, Elizabeth T.; Mock, Stephen; Dmochowski, Roger R.; Reynolds, W. Stuart; Milam, Douglas F.; Kaufman, Melissa R.

doi:10.1177/1756287216679946

Cited by 7 publications

(4 citation statements)

References 19 publications

(48 reference statements)

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“…After urethroplasty recurrent strictures are mainly narrow fibrous rings at the anastomotic sites and usually due to existing pathology of the urethra, local ischaemia or defects in graft uptake [10] . The success rate for single DVIU for these strictures has been reported to be 35% with satisfactory outcomes [11] . Thus, in our present study, postoperative single intervention was considered to treat these ring strictures and was included in the definition of ‘success’.…”

Section: Discussionmentioning

confidence: 99%

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

Chodisetti¹,

Boddepalli²,

Kota³

2018

Arab Journal of Urology

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ObjectiveTo report the surgical details and results of our technique of buccal mucosal graft (BMG) urethroplasty for panurethral stricture, as many studies have reported repair of panurethral stricture by single-stage BMG urethroplasty by placing buccal mucosa ventrally, dorsally or dorsolaterally.Patients and methodsThis was an observational analysis of 38 patients with panurethral stricture treated by placing two BMGs, one as a ventral onlay in the proximal bulbar urethra and the other as a dorsal onlay in the distal bulbar and penile urethra. Success was defined as asymptomatic state with or without need for a postoperative single intervention such as dilatation or internal urethrotomy.ResultsThe 38 patients had a mean age of 44 years, with lichen sclerosus as the predominant cause of stricture. The ultimate success rate was 84.2% at the end of 3 months and 89.5% at the end of 1 year. Recurrent strictures appeared only in the failed cases during the follow-up period of 11 months. None of the patients needed redo urethroplasty during the follow-up period.ConclusionsA proximal ventral and distal dorsal onlay technique of BMG urethroplasty is an available alternative for repairing panurethral stricture. The technique described is simple and easily reproducible with encouraging results compared to other similar techniques.

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Section: Discussionmentioning

confidence: 99%

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

Chodisetti¹,

Boddepalli²,

Kota³

2018

Arab Journal of Urology

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“…In general, the literature supports this management strategy, with reported success rates of DVIU after urethroplasty higher than in primary USD and ranging from 34% to 60.5%. 11 , 21 , 49 , 50 The viability of endoscopic treatment for recurrent bulbar USD in particular is also supported by the OPEN trial with equivalent PROM measures after randomization to DVIU or urethroplasty. 47 Based on these data, it seems likely that many patients with recurrence after urethroplasty will benefit from endoscopic management as an initial attempt, particularly if the nature and extent of the stricture is assessed with imaging and/or cystoscopy and appears amenable to DVIU.…”

Section: Management Approachmentioning

confidence: 96%

Recurrent Anterior Urethral Stricture: Challenges and Solutions

Mershon¹,

Baradaran²

2021

RRU

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Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment "failures". Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

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“…[ 75 ] However, it has been clearly shown that the success rates after repeat urethroplasty are significantly higher compared to DVIU following urethroplasty, which do not exceed 40%–60%. [ 77 78 79 ] DVIU may be an adequate treatment option in cases of a short and focal stricture recurrence at the proximal or distal end of the former graft or EPA after open reconstruction. [ 80 ] Subtle differences could be shown in favor of DVIU after graft substitution compared to DVIU after EPA.…”

Section: Stricture Recurrencementioning

confidence: 99%

Update on managing anterior urethral strictures

Dahlem

Fisch

2019

Indian J Urol

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Direct visual internal urethrotomy for isolated, post-urethroplasty strictures: a retrospective analysis

Abstract: Post-urethroplasty DVIU for isolated, recurrent strictures may be offered as a minimally invasive treatment option. Approximately 40% of patients were spared further intervention.

Cited by 7 publications

References 19 publications

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

Repair of panurethral stricture: Proximal ventral and distal dorsal onlay technique of buccal mucosal graft urethroplasty

Recurrent Anterior Urethral Stricture: Challenges and Solutions

Update on managing anterior urethral strictures

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