European Association of Urology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease

Lumen, Nicolaas; Campos-Juanatey, Félix; Greenwell, Tamsin; Martins, Francisco E.; Osman, Nadir I.; Riechardt, Silke; Waterloos, Marjan; Barratt, Rachel; Chan, Garson; Esperto, Francesco; Ploumidis, Achilles; Verla, Wesley; Dimitropoulos, Konstantinos

doi:10.1016/j.eururo.2021.05.022

Cited by 73 publications

(65 citation statements)

References 96 publications

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“…The success rates after DVIU, AR and GAU are respectively 37% (7/19) and 57% (25/44) at this location [11,15]. In cisgender males, DVIU is a potential firstline treatment for short and primary bulbar strictures, with a patency rate ranging between 26% and 77% being found after a single session [20]. Furthermore, Lumen et al [11] showed that the shorter the time interval between phalloplasty and DVIU, the higher the risk of urethral stricture recurrence.…”

Section: Study Findingsmentioning

confidence: 88%

Treatment of Urethral Strictures in Transmasculine Patients

Waterschoot

Claeys

Verla

et al. 2021

JCM

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Background. Urethral strictures are a common complication after genital gender-affirming surgery (GGAS) in transmasculine patients. Studies that specifically focus on the management of urethral strictures are scarce. The aim of this systematic review is to collect all available evidence on the management of urethral strictures in transmasculine patients who underwent urethral lengthening. Methods. We performed a systematic review of the management of urethral strictures in transmasculine patients after phalloplasty or metoidioplasty (PROSPERO, CRD42021215811) with literature from PubMed, Embase, Web of Science and Cochrane. Preferred Reporting Items for Systematic reviews and Meta-Analysis-(PRISMA) guidelines were followed, and risk of bias was assessed for every individual study using the 5-criterion quality appraisal checklist. Results. Eight case series were included with a total of 179 transmasculine patients. Only one study discussed the management of urethral strictures after metoidioplasty. Urethral strictures were most often seen at the anastomosis between the fixed and pendulous urethra. For each stricture location, different techniques have been reported. All studies were at a high risk of bias. The current evidence is insufficient to favor one technique over another. Conclusions. Different techniques have been described for the different clinical scenarios of urethral stricture disease after GGAS. In the absence of comparative studies, however, it is impossible to advocate for one technique over another. This calls for additional research, ideally well-designed prospective randomized controlled trials (RCTs), focusing on both surgical and functional outcome parameters.

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Section: Study Findingsmentioning

confidence: 88%

Treatment of Urethral Strictures in Transmasculine Patients

Waterschoot

Claeys

Verla

et al. 2021

JCM

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“…Because treatment of long penile urethral strictures using excision primary anastomosis (EPA) can result in loss of penile length and chordee, the European Association of Urology (EAU) guidelines recommend EPA for penile urethral strictures shorter than 1 cm, otherwise augmented urethroplasty. 3 Therefore, augmentation urethroplasty was an appropriate option for the presented case. The success rates of augmented urethroplasty using graft versus flap are still controversial.…”

Section: Discussionmentioning

confidence: 89%

Penoscrotal fistula secondary to urethral diverticulum treated with ventral penile skin flap urethroplasty: A case report

Tuygun

Aghayev

Durak

et al. 2022

Urology Case Reports

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Voiding symptoms and penoscrotal mass with/without fistula are typical findings of urethral diverticulum. We present a case of 55-year-old male patient who was evaluated for voiding symptoms, soft palpable penoscrotal mass and fistula. Retrograde urethrography, scrotal ultrasonography and cystoscopy revealed a urethral diverticulum and fistula. The defect developed after excision of the diverticulum associated with the penile ventral urethra was closed with a penile skin flap. In the 6-month follow-up, the patient did not have any voiding complaints and no signs of recurrence. Urethroplasty using a penile skin flap may be preferred in the repair of penile ventral urethral defect.

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“…Indeed, after urethral augmentation, the ventral flap was covered with the preserved corpus spongiosum, decreasing the risk of diverticulum formation. Another important consideration is that our study included the USS PROM questionnaire [14] for the evaluation of outcomes after surgery, as well as two guideline-approved definitions [22] , [23] of treatment success. The adoption of these two important metrics will facilitate further comparison with similar studies in the future.…”

Section: Discussionmentioning

confidence: 99%

Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures

Joshi

Bandini

Bafna

et al. 2022

European Urology Open Science

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Background Graft plus flap urethroplasty is gaining momentum in patients with nearly or completely obliterated urethral strictures, in whom staged procedures or perineal urethrostomy is the only possible alternative. However, graft plus flap urethroplasty is mainly adopted for strictures involving the penile urethra. Objective To report our experience on graft plus flap urethroplasty for bulbar and penobulbar reconstruction. Design, setting, and participants Between January 2014 and June 2020, patients with nearly or completely obliterated long (>4 cm) bulbar or penobulbar strictures, who required graft plus flap urethroplasty, were considered for this study. Surgical procedure The bulbar and the penile urethra were accessed through a perineal incision and penile invagination when required. Grafts were harvested from cheek, lingual, or preputial skin and quilted over the corpora to reconstruct the dorsal plate of the neourethra. The fasciocutaneous penile flap recreated the ventral plate of the neourethra. The corpus spongiosum was flapped over the neourethra to prevent the formation of diverticula. Measurements Any need for instrumentation after surgery was defined as the primary failure. Obstructive symptoms or maximum flow rate (Qmax) below 10 ml/s, with or without a need for instrumentation, was defined as a secondary failure. Results and limitations We identified 15 patients who met the inclusion criteria. The median stricture length was 7 cm (interquartile range [IQR] 5–8 cm). The inner cheek was the preferred site for graft harvesting (53.3%). No perioperative complication of Clavien-Dindo grade ≥III were recorded in the first 30 postoperative days. The median Qmax at catheter removal was 23 ml/min (IQR 21.5–26 ml/min). The median follow-up was 25 mo (IQR 10–30 mo). The primary success rate was 86.7% (13/15) and the secondary success rate was 73.3% (11/15). Post-traumatic strictures represent a contraindication for this technique. Conclusions In referral centers, graft plus flap urethroplasty represents a feasible option for patients with nearly or completely obliterated long (>4 cm) strictures. Our study demonstrated that this option is also feasible for strictures involving mainly the bulbar urethra. Patient summary Perineal urethrostomy should be considered as the last option in patients with a nearly or completely obliterated bulbar urethral stricture. Nowadays, graft plus fasciocutaneous penile flap augmentation enriched our armamentarium of bulbar urethra reconstruction.

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European Association of Urology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease

Cited by 73 publications

References 96 publications

Treatment of Urethral Strictures in Transmasculine Patients

Treatment of Urethral Strictures in Transmasculine Patients

Penoscrotal fistula secondary to urethral diverticulum treated with ventral penile skin flap urethroplasty: A case report

Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures

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