Pd14-10 a Multiinstitutional Evaluation of the Management and Outcomes of Long Segment and Panurethral Strictures

Warner, Jonathan N.; Malkawi, Ibraheem; Joshi, Panjak; Kulkarni, Sanjay; Barbagli, Guido; Lazzeri, Massimo; Mori, Ryan; Angermeier, Kenneth W.; Han, Jiayu; Gonzalez, Christopher; Martins, Fransisco; Gómez, Reynaldo; Santucci, Richard A.

doi:10.1016/j.juro.2015.02.1339

Cited by 3 publications

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“…Four patients (8.3%) have undergone endoscopic urethrotomy. Median patient's age was 37 [interquartile range (IQR) [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] years in LS group and 54 (IQR 20-84) years in idiopathic group. Stricture length was 8 (IQR 5-8) cm in LS group and 3 (IQR 2.5-4) cm in idiopathic group.…”

Section: Resultsmentioning

confidence: 99%

“…LS is a scar forming disease which in men can cause debilitating and progressive urethral stricture disease (38). LS patients have a higher risk of recurrence after urethroplasty (25-71%) compared to patients undergoing urethroplasty for another cause (10-15%) (31,(39)(40)(41). A recently published systematic review demonstrated no significant difference between the pooled recurrence rate in patients with LS compared to patients without LS (P=0.36).…”

Section: Discussionmentioning

confidence: 99%

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Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

Hevia¹,

Fraile²,

Sanz³

et al. 2022

Transl Androl Urol

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Background: Lichen sclerosus (LS) is one of causes of male urethral stricture, mainly penile or anterior urethra, and frequently associated with phimosis. This disease involves penile skin and surrounding tissues, which might affect long-term graft survival after a substitution urethroplasty. The aim of this study is to assess LS impact on urethral grafts, comparing outcomes in the LS group versus idiopathic urethral stricture.Methods: Retrospective descriptive analysis of male patients who underwent urethroplasty with buccal mucosa graft (BMG) at our academic institution during the last decade [2008][2009][2010][2011][2012][2013][2014][2015][2016][2017][2018][2019][2020][2021]. Patients were allocated to LS group or idiopathic group depending on the aetiology of urethral stricture. The LS was confirmed by histology. Data collected included patient baseline characteristics, stricture description, perioperative parameters, surgical technique and outcomes. Kaplan-Meier survival analysis was performed to assess graft survival in both groups, as univariate and multivariate analysis were performed trying to identify independent risk factors for graft survival. Primary outcome was treatment success, defined as the no need for further treatments.Results: Forty-eight male patients underwent substitution urethroplasty, 11 in LS group and 37 in idiopathic group. Baseline characteristics between both groups were different mainly in terms of age and stricture features (length), with larger strictures in LS group (6.8 vs. 3.5 cm). All grafts were procured from buccal mucosa, while no differences in grafts survival were observed between both groups (40.3 vs. months).Mean of patient global impression of improvement (PGI-I) score was 2.1 in LS group vs.2.4 in idiopathic group. Age, aetiology and smoking habit seems to be independent risk factors for graft survival, but not in multivariate analysis.Conclusions: Patients with LS have longer strictures than idiopathic group. No differences were found in graft survival between both groups and independent risk factor for graft survival were not identified.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

Hevia¹,

Fraile²,

Sanz³

et al. 2022

Transl Androl Urol

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“…Dubey et al reported on their experience comparing the one-stage Kulkarni technique and two-stage repairs for panurethral strictures secondary to lichen-sclerosus [22]. They concluded that one-stage procedures had better success, and while staged procedures could be successful, they were fraught with technical difficulties and multiple revisions.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Single Stage OMG Urethroplasty by Kulkarni Technique in Comparison With Johanson’s Staged Urethroplasty for Management of Pan-Urethral Stricture

Islam¹,

Asaduzzamman²,

Ahmed³

et al. 2020

Bang J Urology

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Purpose: To observe the outcome of single stage buccal mucosal graft and Johanson’s staged urethroplasty for treatment of pan- urethral stricture. Materials and Methods: A total of 60 patients with an average age of 42 years (21-55) underwent OMG urethroplasty and Johanson’s staged urethroplasty between March 2008 to September 2015 for pan-urethral stricture of different etiology. OMG was always harvested from cheek using 2 team approaches. Graft was placed using Kulkarni technique. Clinical outcome was considered success or failure if any post operative procedure needed. Mean follow up was 45 month (6-95) Results: Total 60 patients were included for final calculation, 31 patients with buccal mucosal graft (Group A) and 29 patients with Johanson’s staged urethroplasty (Group B) were followed up for average 45 months. Success rate of group A was 93.5% at 3 months and 77.4% at 3 years and in group B 65.5% at 3 months and 44.8% at 3 years follow up which is statiscally significant (p <.05). Postoperative complications were significantly higher in group-B. Conclusion: Repair of pan-urethral stricture in a single-stage OMG by Kulkarni technique is simple, fast, safe, effective and reproducible in the hand of any surgeon. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.78-84

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“…Comparing Postoperative Recurrence in Patients with and without LS Data from 15 of 21 studies were extracted for inclusion in our comparative analyses. Operative technique was consistent between all patients with and without LS within each study, except for 2, 5,30 from which we excluded the data/outcomes for 43 patients without LS in our analysis (supplementary table 1, https://www.jurology.com). In total, we included 416 patients with LS and 433 patients without LS.…”

Section: Subgroup Analyses To Determine Impact Of Operative Techniquementioning

confidence: 99%

One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis

2021

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Performing 1-stage urethroplasty in patients with urethral strictures caused by lichen sclerosus (LS) is hotly debated among reconstructive urologists due to conflicting reports of success. Therefore, the objective of this study was to determine the pooled incidence of stricture recurrence following 1-stage buccal mucosal graft (BMG) urethroplasty in patients with LS, to determine the impact of surgical technique on recurrence and to compare recurrence risk between patients with and without LS after 1-stage repairs. Materials and Methods: A systematic review was conducted in accordance with PRISMA criteria. The primary outcome was pooled incidence of recurrence, which was calculated using a Der-Simonian-Laird binary random effects model with a Freeman-Tukey arcsine transformation. A total of 21 studies were included, of which 15 provided data for comparative analyses. Results: Pooled data from 625 LS patients revealed a stricture recurrence rate of 10% (95% CI 6e14). Among studies with longer followup (!24 months), this increased to 18%. Among patients with penile urethral involvement, studies utilizing a penile skin incision had significantly higher pooled recurrence rates than those utilizing penile invagination (p[0.004). Across all studies, there was no evidence to suggest a difference in pooled recurrence rate between patients with and without LS (p[0.36). However, across only long-term studies, recurrence risk was significantly higher for patients with LS (OR 1.83, p[0.05). Conclusions: One-stage BMG urethroplasty is likely a viable surgical option for patients with LS-related strictures; however, high-quality data are limited. Future multi-institutional, long-term prospective studies are needed to assess durability of 1-stage repair.

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Pd14-10 a Multiinstitutional Evaluation of the Management and Outcomes of Long Segment and Panurethral Strictures

Cited by 3 publications

References 0 publications

Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

Outcome of Single Stage OMG Urethroplasty by Kulkarni Technique in Comparison With Johanson’s Staged Urethroplasty for Management of Pan-Urethral Stricture

One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis

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