European Association of Urology Guidelines on Urethral Stricture Disease (Part 2): Diagnosis, Perioperative Management, and Follow-up in Males

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

doi:10.1016/j.eururo.2021.05.032

Cited by 41 publications

(55 citation statements)

References 53 publications

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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%

“…Indeed, erectile function scores and penile Doppler findings were not assessed in our patients. Lastly, we acknowledge that no routine retrograde urethrogram were performed 12 mo after surgery, as it is now recommended by guidelines in these complex cases [23] . In summary, our study joins previous publications on single-stage graft plus flap urethroplasty expanding our knowledge on this challenging reconstructive surgery.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…По данным литературы, в последние годы при осложненных и протяженных стриктурах чаще отдается предпочтение увеличительной или двухэтапной заместительной уретропластике с использованием свободных трансплантатов [3,6,[18][19][20][21][22][23]. Популяризатор данной методики A. Bracka в 1995 г. представил выдающиеся функциональные и косметические результаты лечения гипоспадий с использованием свободных трансплантатов в этапных реконструкциях [24,25].…”

Section: Discussionunclassified

“…В соответствии с клиническими рекомендациями последних лет малоинвазивные методы, и в частности внутренняя оптическая уретротомия, не используются в подобных случаях в связи с риском эректильных дисфункций [6].…”

Section: Introductionunclassified

Urethral strictures in boys after hypospadias treatment: two-staged buccal urethroplasty

Ladygina

Demin²,

Nikolayev

2022

Androl. genit. hir.

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Introduction. The most common cause of urethral strictures in boys is a complication of hypospadias treatment. Extended and complicated strictures represent the most difficult segment of the problem and the choice of the method of surgical correction.The study objective is to review the technique and results of replacement urethroplasty with buccal graft in urethral strictures that occurred after treatment of hypospadias in childhood.Materials and methods. A retrospective study conducted at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma from 2017 to 2020. Cases of 34 patients who underwent staged replacement buccal urethroplasty for complicated urethral stricture were studied. The examination revealed complications such as: Lichen sclerosus, short urethra, fistulas, diverticula, multiple (double) and extended strictures.Results. Complications occurred in 3 (8.8 %) patients: cutaneous urethral fistula developed in two, partial scarring of the free graft occurred in one child. Long-term results were assessed after an average of 16 months. Our experience of treating 34 pediatric and adolescent patients with p after-hypospadias strictures showed that the leading cause of stricture formation after hypospadias treatment is Lichen sclerosus, which occurred in 16 patients.Conclusion. During the last century, many donor tissues have been proposed for free urethroplasty, but it is the buccal graft that has won the largest number of supporters, and two-staged urethroplasty has become the method of choice for strictures of the anterior urethra. The surgeon’s considerable experience in performing buccal urethroplasty, adherence to the nuances of the technique and methodology of postoperative management, both at the first and second stages, allows you to obtain a good cosmetic and functional result even after a number of unsuccessful operations.

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“…Definition of a female urethral stricture is subject to debate and standardization is currently still lacking. Most series report a urethral calibre <14 French as the threshold for a female urethral stricture [1,9].…”

Section: Discussionmentioning

confidence: 99%

Female Urethroplasty: Outcomes of Different Techniques in a Single Center

Waterloos

Verla

Wirtz

et al. 2021

JCM

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Introduction: Female urethral strictures and injuries are relatively uncommon compared to males. A wide range of possible causes and treatment modalities have been described. Lately female urethral reconstruction is gaining attention and is fortunately no longer a neglected topic within the reconstructive urology. As such, we aimed to describe our surgical techniques and outcomes for female urethroplasty from a tertiary center. Materials and Methods: Records of female patients who underwent a urethroplasty between July 2018 and May 2021 in our tertiary referral center were reviewed. Patients were subdivided in two groups: patients who suffered from a urethral injury and received an early repair urethroplasty, and patients with a true urethral stricture who received a delayed urethroplasty. Preprocedural, surgical and postoperative data were collected and analyzed with descriptive statistics. Results: A total of five patients in group 1 and nine patients in group 2 were included. Etiology of the urethral injury in group 1 was iatrogenic in 80% and transitional cell carcinoma of the urethra in 20% of cases. A patency rate of 100% at a follow-up of 30 months was achieved with the different techniques. In group 2 etiology was idiopathic (44%), iatrogenic (44%) and due to external trauma in 12% of cases. Urethroplasty technique consisted of primary repair or dorsal onlay of a buccal mucosal graft. Patency rate was 100% at a median follow-up of 13 months. Three patients suffered from postoperative urinary incontinence, one in group 1 and two in group 2. Conclusion: Female urethroplasty is a relatively rare entity within reconstructive urethral surgery. This case series of 14 patients demonstrates that with appropriate surgical techniques, a high patency rate with a low complication rate can be achieved. Further prospective studies with standardized diagnostic workup and follow-up should be performed in order to optimize management strategy.

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European Association of Urology Guidelines on Urethral Stricture Disease (Part 2): Diagnosis, Perioperative Management, and Follow-up in Males

Cited by 41 publications

References 53 publications

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

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

Urethral strictures in boys after hypospadias treatment: two-staged buccal urethroplasty

Female Urethroplasty: Outcomes of Different Techniques in a Single Center

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