Predictors of urethral stricture recurrence after endoscopic urethrotomy

Redón-Gálvez, Laura; Molina-Escudero, R.; Álvarez-Ardura, M.; Otaola-Arca, Hugo; Parra, R.O. Alarcón; Páez-Borda, Á.

doi:10.1016/j.acuroe.2016.07.008

Cited by 11 publications

(10 citation statements)

References 17 publications

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“…However, studies have shown that stricture recurs in nearly 100% of cases in the postoperative period and that repeat DVIU sessions worsen stricture and fibrosis. 5 As a result, guidelines or panels recommend urethroplasty surgeries for patients with recurrent stricture after one session of DVIU (apart from patients who cannot have urethroplasty due to comorbid problems). 6 Urethroplasty provides more successful results for those without dilatation, DVIU and urethroplasty performed or for uncomplicated stricture.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and predictive factors for re-stricture with urethroplasty methods for anterior urethra stricture

Güler

2023

Urologia

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Objectives: We wished to compare the treatment success of urethroplasty methods (EPA and BMG) used for anterior urethra stricture after unsuccessful internal urethrotomy. Methods: A total of 85 and 51 patients, respectively, who underwent excision and primary anastomosis (EPA) and buccal mucosal graft (BMG) urethroplasty due to recurrent strictures after direct vision internal urethrotomy (DVIU) were evaluated retrospectively. On the uroflowmetry test, >15 ml/s urine flow and residual urine (PVR) below 50 ml were determined as success criteria. Cox regression analysis investigated the probable predictive factors for surgery success. Kaplan-Meier analysis assessed stricture free survival after redo-urethroplasty. Results: After surgery, EPA and BMG patients were followed for 31.9 ± 9.8 (4–40) and 30.7 ± 10.3 (4–40) months. At the end of this follow-up duration, success was obtained for 71 (83.5%) and 44 (86.3%) patients. Mean re-stricture times were 13.9 ± 6.0 (4–19) and 10.2 ± 5.1 (4–26) months. Most re-strictures had penile location (10 (71.5%) and 7 (100%)). After one session of DVIU, there was 100% success in both groups, but after >3 sessions of DVIU, success fell to 70.3% and 78.3% in the groups respectively. Patients with high numbers of DVIU sessions had longer durations for urethroplasty surgery. Apart from complications related to the donor field in the oral region with BMG and four patients who developed fistula (7.8%), complications were similar in both groups. Conclusions: In this series of cases, it was not possible to identify which of the techniques employed provides the best result or predictive factors for stenosis recurrence after correction procedures for anterior urethral stenosis.

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Section: Discussionmentioning

confidence: 99%

Outcomes and predictive factors for re-stricture with urethroplasty methods for anterior urethra stricture

Güler

2023

Urologia

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“…In a study by Redón-Gálvez et al 20 25 patients with recurrence were divided into 3 groups according to their postoperative follow-up duration with a urethral catheter as less than 7 days, 7-15 days, and more than 15 days. In these groups, recurrence occurred in 48.4%, 19.2%, and 50%, respectively, with a statistically significant difference.…”

Section: Discussionmentioning

confidence: 99%

Male Urethral Stricture in Patients with Metabolic Syndrome

Asfuroglu¹,

Balci²,

Köseoğlu³

et al. 2023

Urol Res Pract

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Objective: Urethral stricture is characterized by fibrosis that decreases urine flow. Metabolic syndrome is a complex disorder that causes fibrosis in many organs. This study aimed to evaluate the relationship between metabolic syndrome and appearance of urethral stricture and effects of metabolic syndrome on the recurrence of urethral stricture in patients with primary urethral stricture who underwent direct visual internal urethrotomy. Materials and methods: One hundred thirty-two male patients who underwent direct visual internal urethrotomy between 2014 and 2021 because of primary urethral stricture were included. Location, length, and type of urethral stricture, time from diagnosis to surgery, postoperative follow-up, time from surgery to recurrence, and postoperative follow-up duration with a urethral catheter were retrospectively analyzed and association with metabolic syndrome was evaluated. Results: The mean age was 50.48 ± 17.94 years. Recurrence was found in 34.1% and metabolic syndrome in 27.3%. Postoperative follow-up duration was significantly longer in patients with recurrence than in those without ( P = .033). There was no statistically significant difference in terms of metabolic syndrome and postoperative urethral catheterization between patients with and without recurrence ( P = .126, P = .714, respectively). Postoperative clean intermittent self-catheterization use was found to be statistically higher in patients with recurrence than in patients without recurrence ( P = .018). Postoperative urinary tract infection rate was found to be significantly higher in patients with metabolic syndrome compared to patients without metabolic syndrome ( P = .001). Conclusion: Metabolic syndrome was not associated with recurrence. However, postoperative urinary tract infections were more common in patients with metabolic syndrome than in patients without. Clean intermittent self-catheterization used postoperatively may increase the risk of stricture.

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“…For patients with urethral stricture length of over 1cm, the risk of stricture recurrence following urethral dilatation of DVIU has been demonstrated to be significantly higher. 36,53,55 Other factors associated with increased stricture recurrence risk include penile and membranous urethral strictures, 20,21,54 patients with strictures at multiple locations across the urethral length, 20,55 those who have undergone previous urethral dilatations of DIVU, 22 or in patients with extensive periurethral spongiofibrosis. 1,56 Patients who are elderly, obese, 57 or had untreated pre-operative urinary tract infection 25 also have been reported to have a higher risk of urethral stricture recurrence following DVIU or urethral dilatations.…”

Section: Predictors Of Stricture Recurrence Following Endoluminal or mentioning

confidence: 99%

Endoluminal and Endoscopic Management of Urethral Stricture

Mak¹,

Lam²,

Tsu³

2020

Journal of Endoluminal Endourology

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Background and ObjectiveUrethral stricture in the male population is one the oldest described urological condition. Significant vari-ability in clinical practice means that standardized management of urethral stricture remains controversial. Since the first description of modern-day direct visual internal urethrotomy (DVIU) by Sachse in 1974, this, alongside with various endoscopic treatment techniques, continues to be by far the most commonly performed procedures for the management of urethral strictures. This article aims to summarise and review the latest literature on endoscopic management of urethral strictures. Material and MethodsWe conducted a Pubmed and Medline search to identify publications related to endoscopic management of male urethral strictures between 1980 and 2019. Preference was given to recent and larger studies. Original research articles, review articles, abstracts, and opinion articles were included. Keywords used for the search were “male urethral stricture,” “urethrotomy,” “DVIU,” “urethral dilation,” “urethral stent”, “intermittent self-catheterisation”, “mitomycin C”, “steroids”, and “urethroplasty.” Recent FindingsThe long-term efficacy of endoscopic management of urethral stricture is poor. Recent novel advances with adjunct treatment have yet to demonstrate improvement in long-term treatment success. Repeated endoluminal or endoscopic treatments, especially for long and recurrent urethral strictures, are ineffective. They appear to delay patients from receiving definitive treatments, and potentially increase complexity and decrease the success rate of any future urethral reconstructive treatment. SummaryThere is overwhelming evidence to suggest limited long-term efficacy of endoluminal or endoscopic treat-ments for urethral stricture. Novel adjunctive therapies showed promising initial results, but none have yet to demonstrate durable efficacy. Endoscopic treatment of urethral stricture disease should only be reserved for patients who are not willing to undergo reconstructive surgery, or not fit for anesthetics.

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Predictors of urethral stricture recurrence after endoscopic urethrotomy

Cited by 11 publications

References 17 publications

Outcomes and predictive factors for re-stricture with urethroplasty methods for anterior urethra stricture

Outcomes and predictive factors for re-stricture with urethroplasty methods for anterior urethra stricture

Male Urethral Stricture in Patients with Metabolic Syndrome

Endoluminal and Endoscopic Management of Urethral Stricture

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