Internal Urethrotomy Versus Dilation as Treatment for Male Urethral Strictures: A Prospective, Randomized Comparison

Steenkamp, Janami; Heyns, Chris F.; Kock, M. L. S. De

doi:10.1016/s0022-5347(01)65296-0

Cited by 286 publications

(185 citation statements)

References 17 publications

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“…However, it should be kept in mind that the stricture may recur after ending the catheterization (9). Some patients may be treated with periodic Benique bougie dilations.…”

Section: Discussionmentioning

confidence: 99%

Analysis of recurrent urethral strictures due to iatrogenic urethral trauma

Kızılay¹,

Şimşir²,

Ozyurt³

2017

Turk J Med Sci

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Background/aim: We aimed to analyze the effects of stricture location, etiology, age, and catheterization time on recurrence rate and recurrence time in patients who underwent direct vision internal urethrotomy (DVIU) for urethral strictures. Materials and methods:Patients were divided into three groups according to the location of the stricture: penile urethra, membranous urethra, and prostatic urethra strictures. Patients were also divided into three groups according to etiologic factors: strictures secondary to endoscopic procedures, urethral catheterization, and open or radical prostatectomy (anastomotic strictures were included in this group). Patients were also divided into three groups according to catheterization time: <2, 2-5, and >5-7 days. Recurrence rate and time data were analyzed according to stricture location, etiology, age, and catheterization time.Results: The recurrence rate was significantly higher in endoscopic procedures. Recurrence rate was significantly lower and recurrence time was significantly earlier in penile urethral strictures. Recurrence rate was significantly lower and recurrence time was significantly longer in short catheterized group than in the other two groups. However, first recurrence time was not different between the groups, while second and multiple recurrence times were significantly earlier in patients <60 years old. Conclusion:Patients are exposed to multiple operations as a result of frequently recurring urethral strictures. Although DVIU is an important first-line treatment method for strictures, alternative methods should be considered for frequently recurring cases.

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“…However, it should be kept in mind that the stricture may recur after ending the catheterization (9). Some patients may be treated with periodic Benique bougie dilations.…”

Section: Discussionmentioning

confidence: 99%

Analysis of recurrent urethral strictures due to iatrogenic urethral trauma

Kızılay¹,

Şimşir²,

Ozyurt³

2017

Turk J Med Sci

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“…[5] The results are worst for long-segment (>2 cm) strictures. [6] So the option is urethroplasty! But it remains to be underutilized with few institutes offering the present standard of care.…”

Section: Discussionmentioning

confidence: 99%

Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty

Pathak¹,

Jain²,

Bhujbal³

et al. 2017

Turkish Journal of Urology

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Objective: To compare long-term outcomes of buccal mucosa graft (BMG) augmentation urethroplasty for long segment bulbar urethral strictures done by placing the graft ventrally, dorso-laterally and dorsally. Material and methods:We conducted a single institution retrospective study on 112 who underwent BMG augmentation urethroplasty for non-traumatic bulbar urethral strictures between January 2005 to December 2014. The cases were divided into three groups based on the site of placement of BMG graft i.e. (a) Ventral (n=44), (b) Dorso-lateral (n=48) and (c) Dorsal (n=20). Follow-up period was from one year to five years. Patients with failed outcomes underwent urethroscopy or retrograde urethrogram to note the site of recurrence of stricture. Results:Out of 112 cases 91 (81%) were successful and 21 (19%) failed. The success rates for ventral, dorsolateral and dorsal BMG augmentation procedures were 89%, 79% and 70%, respectively (p= 0.18). Among 21 failed cases, 12 cases (57%) had stricture at proximal anastomotic site, 4 cases (19%) at graft and 5 cases (24%) at distal anastomotic site (p= 0.01). Conclusion:The overall success rate for BMG augmentation urethroplasty is equal for all techniques. Ventral onlay urethroplasty provides better exposure of proximal anastomotic site thus it is associated with minimum proximal anastomotic site recurrence rates. Patients with extensive spongiofibrosis and long segment strictures had higher rates of failure.

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“…With a limited amount of substitution tissue, urethral reconstruction will require a combination of grafts and/or flaps as the stricture length increases, thus increasing the complexity of surgery. Also, stricture recurrence is known to be higher after endoscopic urethrotomy for longer strictures, 15,16 as well as after open reconstruction. In a recent multivariate analysis of risk factors for stricture recurrence after urethroplasty, stricture length (especially >4 cm) predicted failure.…”

Section: Reconstruction Level Assignedmentioning

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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Internal Urethrotomy Versus Dilation as Treatment for Male Urethral Strictures: A Prospective, Randomized Comparison

Cited by 286 publications

References 17 publications

Analysis of recurrent urethral strictures due to iatrogenic urethral trauma

Analysis of recurrent urethral strictures due to iatrogenic urethral trauma

Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty

The UREThRAL stricture score: A novel method for describing

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