Free Graft Augmentation Urethroplasty for Bulbar Urethral Strictures: Which Technique Is Best? A Systematic Review

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

doi:10.1016/j.eururo.2021.03.026

Cited by 14 publications

(7 citation statements)

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“…1 The gold standard treatment is urethroplasty, with success rates ranging from 80%–95%, depending on stricture characteristics. 2–4 Despite guidelines encouraging urethroplasty for longer or recurrent strictures, the vast majority are treated endoscopically. 5–8 Endoscopic treatments include direct vision internal urethrotomy (DVIU) and urethral dilation, with success rates of 50%–70% for short, treatment-naïve strictures and a lower success for recurrent strictures.…”

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confidence: 99%

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume ^® Drug-Coated Balloon for Anterior Urethral Strictures

et al. 2022

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The Optilume ® Drug Coated Balloon (DCB) is a urethral dilation balloon with a paclitaxel coating that combines mechanical dilation for immediate symptomatic relief with local drug delivery to maintain urethral patency. The ROBUST III study is a randomized, single blind trial evaluating the safety and efficacy of the Optilume DCB against endoscopic management of recurrent anterior urethral strictures. Materials and Methods: Eligibility criteria were: adult men with anterior strictures ≤12F in diameter and ≤3cm in length, at least 2 prior endoscopic treatments, International Prostate Symptom Score ≥11, and maximum flow rate <15 mL/sec. 127 subjects were enrolled at 22 sites. The primary study endpoint was anatomic success (≥14F by cystoscopy or calibration) at 6 months. Key secondary endpoints included freedom from repeat treatment, International Prostatic Symptom Score (IPSS), and peak flow rate (Qmax). The primary safety endpoint included freedom from serious device or procedure related complications. Results: Baseline characteristics were similar between groups, with subjects having an average of 3.6 prior treatments and average length of 1.7cm. Anatomic success for Optilume DCB was significantly higher than Control at 6 months (75% vs 27%, p<0.001). Freedom from repeat intervention was significantly higher in the Optilume DCB arm. Immediate symptom and urinary flow rate improvement was significant in both groups, with the benefit being more durable in the Optilume DCB group. The most frequently adverse events included urinary tract infection, postprocedural hematuria, and dysuria. Conclusions: The results of this randomized controlled trial support that Optilume is safe and superior to standard DVIU/dilation for the treatment of recurrent anterior urethral strictures <3cm in length. The Optilume DCB may serve as an important alternative for men that have had an unsuccessful DVIU/dilation but want to avoid or delay urethroplasty.

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confidence: 99%

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume ^® Drug-Coated Balloon for Anterior Urethral Strictures

et al. 2022

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“…As of yet, one of the main rationales to promote a dorsal‐onlay approach is the supposed advantage of dorsal graft coverage through the corpora cavernosa to avoid sacculation and to provide a well‐vascularised graft bed. However, an increased risk for diverticulation or post‐void dribbling proved anecdotal according to a recent systematic review [4]. In our opinion, adequate tailoring of the graft, spongioplasty, and tight, multilayer closure combine the most effective and sufficient measures to mitigate aforementioned risks when using a ventral onlay.…”

Section: Discussionmentioning

confidence: 93%

“…The same holds true for ntAAU, only one recent very small series has mentioned ventral grafting as an option and performed a ventral ntAAU in three patients [28]. Pending results from the DoVe trial (NCT04551417), the comparative effectiveness of different grafting positions is not known and has not been undergirded by high-level evidence [1,4]. As of yet, one of the main rationales to promote a dorsalonlay approach is the supposed advantage of dorsal graft coverage through the corpora cavernosa to avoid sacculation and to provide a well-vascularised graft bed.…”

Section: Discussionmentioning

confidence: 99%

“…Short bulbar strictures (≤2 cm) are usually suitable for excision and primary anastomosis (EPA), whereas longer strictures require augmentation urethroplasty (AU) [1,3]. Both provide longterm success rates of >80% for bulbar stricture repair [4]. In Original Article cases of variable stricture morphology with inherent complicating factors, surgeons sometimes have to deviate from basic standard techniques.…”

Section: Introductionmentioning

confidence: 99%

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Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

et al. 2023

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ObjectivesTo present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long‐term objective and patient‐reported outcomes.Patients and methodsWe considered patients undergoing bulbar buccal mucosal graft urethroplasty (BMGU) between July 2016 and December 2019. Eligibility criteria for mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty were strictures of ≥2 cm with an obliterative segment of ≤1.5 cm. The stricture is approached ventrally to avoid extensive dissection and mobilisation. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated patient‐reported outcome measures on voiding, erectile, and continence function. We evaluated functional follow‐up, incorporating patient‐reported (lower urinary tract symptoms [LUTS] score) and functional success. Recurrence was defined as need of re‐treatment.ResultsOf 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a history of dilatation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%), and the mean (SD) graft length was 4.5 (1.4) cm. At a median (interquartile range) follow‐up of 41 (27–53) months, the functional success rate was 93%. Whereas the median LUTS score significantly improved from baseline to postoperatively (13 vs 3.5; P < 0.001), there was no change in erectile function (median International Index of Erectile Function – erectile function domain score 27 vs 24) or urinary continence (median International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form sum score 0 vs 0; all P ≥ 0.4). All patients were ‘satisfied’ (27%) or ‘very satisfied’ (73%) with the outcome of their operation.ConclusionWith excellent long‐term objective and patient‐reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.

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“…The treatment of bulbar urethral strictures is a complicated clinical problem [ 1 ]. In addition to riding injury, iatrogenic factors (such as intravenous catheterization, minimally invasive transurethral surgery (such as TURP, TURBT, ureteroscopy and lithotripsy) are among the common causes of bulbar urethral strictures [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment

et al. 2023

Basic Clin. Androl.

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Background This study aimed to compare the clinical outcomes of non-transecting urethroplasty and lingual mucosal urethroplasty in the treatment of iatrogenic bulbar urethral stricture. Results A total of 25 patients with iatrogenic bulbar urethral stricture were enrolled, 12 of whom underwent lingual mucosal urethroplasty, 13 patients who underwent non-transecting urethroplasty. All patients were followed-up and evaluated at 3 postoperative months. Evaluations included urethrography, maximum urine flow rate (Qmax), nocturnal erectile function testing, International Index of Erectile Function (IIEF-5) assessment, and Anxiety Related Scale (SAS) assessment. In terms of operation time, there was a significant difference between non-transecting urethroplasty and lingual mucosal urethroplasty. However, there was no significant intergroup difference in intraoperative blood loss. Both techniques were associated with significantly improved Qmax relative to preoperative rates, but there was no significant difference between the groups in this regard over 3 months of postoperative follow-up. Nocturnal penile tumescence and rigidity results showed that there was no significant change in tip hardness after surgery in the non-transecting urethroplasty group. Moreover, IIEF-5 scores indicated that there was no significant intergroup difference in terms of subjective postoperative erectile function. According to the preliminary psychological evaluations during postoperative follow-up, the anxiety scores of patients undergoing non-transecting urethroplasty significantly improved, but there was no significant change in the mean SAS score among patients who underwent lingual mucosal urethroplasty. Conclusion Both surgical methods can achieve the clinical goal of treating iatrogenic bulbar urethral stricture. Non-transecting urethroplasty has the characteristics of short operation time, relative technical simplicity, and retention of the original erectile function of most patients, and the surgical outcomes of non-transecting urethroplasty are not inferior to those of lingual mucosal urethroplasty, and it is a promising technique for widespread use to treat bulbar urethral strictures.

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Free Graft Augmentation Urethroplasty for Bulbar Urethral Strictures: Which Technique Is Best? A Systematic Review

Cited by 14 publications

References 50 publications

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume ^® Drug-Coated Balloon for Anterior Urethral Strictures

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume ^® Drug-Coated Balloon for Anterior Urethral Strictures

Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment

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Free Graft Augmentation Urethroplasty for Bulbar Urethral Strictures: Which Technique Is Best? A Systematic Review

Cited by 14 publications

References 50 publications

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume ® Drug-Coated Balloon for Anterior Urethral Strictures

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume ® Drug-Coated Balloon for Anterior Urethral Strictures

Mucomucosal anastomotic non‐transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures

Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment

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Product

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One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume ^® Drug-Coated Balloon for Anterior Urethral Strictures

One-Year Results for the ROBUST III Randomized Controlled Trial Evaluating the Optilume ^® Drug-Coated Balloon for Anterior Urethral Strictures