Prevention of Stricture Recurrence Following Urethral Endoscopic Management: What Do We Have?

Tian, Ye; Wazir, Romel; Yue, Xuan; Wang, Kun‐Jie; Li, Hong

doi:10.1089/end.2013.0538

Cited by 28 publications

(26 citation statements)

References 61 publications

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“…However, it is known that ischemia is involved in the process of recurrence of urethral stricture in most cases (11). Due to the pressure they exert on the urethral wall, larger diameter catheters may interfere with re-epithelialisation, which would result in urethral healing (12,13).…”

Section: Discussionmentioning

confidence: 99%

Which Factors Affect the Hospital Re-admission After Treatment Approaches to Urethral Strictures?

Girgin¹

2017

jus

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Objective: To investigate patient-and procedure-related factors associated with hospital re-admission following urethral manipulations for the treatment of urethral strictures. Materials and Methods: Data of patients who underwent dilation or internal urethrotomy for urethral strictures between 2011 and 2016 were retrospectively analyzed. Patients who were admitted to our institute for any reason within one month after hospital discharge were evaluated. The patient-and procedure-related factors affecting the readmission rates were revealed by multiple binary logistic regression using stepwise backward elinimination. Results:The average age of 76 male patients was 61.7±14.4 years. The mean maximal flow rate at preoperative uroflowmetry was 6.01±4.3 and the median American Society of Anesthesiologists score was 2.38. The process was the first for 45 (59.2%) patients, the second for 16 (21.1%) patients, the third for 9 (11.8%) patients, and the fourth for 6 (7.9%) patients. Amplatz dilators, cold knife and Ho:YAG laser were used in 50%, 27.6% and 22.4% of patients, respectively. The mean length of hospital stay was 0.89±0.31 days, and the complication rate was 19.7% (15/76). The mean urethral catheter dwell time was 8.9±14.2 day. Overall, the procedure was successful in 61 (80.3%) patients and failed (Q max <15 mL/sec) in 19.7% of the cases. Fifteen (19.7%) patients were re-admitted, while 2 (2.6%) patients among them were re-hospitalized for further treatment. Comorbidity and age were independent predictors of re-admission. Conclusion: We found that younger age and lower comorbidities predicted hospital re-admission following procedures for urethral strictures. Keywords: Urethral strictures, re-admission, risk factor Amaç: Üretral darlıklara müdahale edildikten sonra hastaneye tekrar başvuru nedenleri ile ilişkili hasta ve prosedüre bağlı faktörleri araştırmaktır. Gereç ve Yöntem: 2011 ile 2016 yılları arasında üretra darlığı nedeni ile dilatasyon veya internal üretrotomi uygulanan hastaların tıbbi kayıtları retrospektif olarak incelendi. Hastaneden taburcu olduktan sonraki 30 gün içinde hastaneye herhangi bir sebeple yeniden başvuran hastalar değerlendirildi. Tekrar başvuru oranlarını etkileyen hasta ve prosedüre bağlı faktörler, geriye doğru kademeli çoklu ikili lojistik regresyon analizi kullanılarak ortaya çıkarıldı. Bulgular: Yetmiş altı erkek hastanın yaş ortalaması 61,7±14,4 yıldı. Preoperatif üroflowmetride ortalama maksimal akım hızı 6,01±4,3, ortalama Amerikan Anesteziyologları Derneği skoru 2,38 idi. Kırk beş (%59,2) hastada birinci, 16 (%21,1) hastada ikinci, 9 (%11,8) hastada üçüncü, 6 (%7,9) hastada dördüncü kez işlem yapıldı. Amplatz dilatörleri, soğuk bıçak ve Ho:YAG lazeri sırasıyla %50, %27,6 ve %22,4 hastalarda kullanıldı. Ortalama yatış süresi 0,89±0,31 gün, komplikasyon oranı %19,7 (15/76) idi. Ortalama uretral kateterin kalma süresi 8,9±14,2 gündü. Toplam 61 (%80,3) hastada başarı elde edildi. Olguların %19,7'sinde işlem başarısız oldu (Q maks <15 mL/sn). On beş (%19,7) hasta hastaneye tekrar...

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Section: Discussionmentioning

confidence: 99%

Which Factors Affect the Hospital Re-admission After Treatment Approaches to Urethral Strictures?

Girgin¹

2017

jus

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“…However, it is known that, ischemia is involved in the process of stricture formation in most of the recurrent urethral stricture cases. [18] Due to the pressure that they apply on the wall of the urethra, larger bore catheters may decrease the blood flow and hinder the re-epithelization process that will eventually end with the healing of the incised urethra with fibrosis. [19,20] Decreasing the catheter size from 22Fr to 18Fr significantly decreased the risk of fossa navicularis strictures (6.9% vs. 0.9%, p=0.02) without increasing the complications after robotic assisted laparoscopic radical prostatectomy.…”

Section: Discussionmentioning

confidence: 99%

Catheter dwell time and diameter affect the recurrence rates after internal urethrotomy

Yürük

Yentur

Çakır

et al. 2016

Turkish Journal of Urology

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Objective: Cold-knife direct vision internal urethrotomy (DVIU) is frequently used as the first-line treatment for urethral stricture disease. Although the steps of the procedure are defined in detail, the duration of catheterization and the diameter of the catheter to be used after the operation are not clearly defined. The aim of this study is to evaluate the effects of catheter dwell time and diameter on recurrence rates of urethral stricture disease after DVIU. Material and methods:Data of 193 consecutive treatment naïve bulbar urethral stricture patients who underwent DVIU between January 2009 and June 2013 were retrospectively analyzed. Patient demographics and stricture characteristics were noted. Catheter dwell times were grouped as <5 and ≥5 days. The diameters of catheters used were 16, 18 and 22 Fr. The association between recurrence rates, catheter dwell times, and diameter were evaluated with Tukey's test and Pearson's correlation test, respectively. Results:Overall 193 patients with a mean age of 64.51±12.99 (range: 17 to 85) years were enrolled in the study. Urethral stricture disease recurred in 45 (23.31%) patients within the first year after DVIU. Mean duration of catheterization was 7.47±4.03 and 4.79±1.94 days in patients with and without recurrences, respectively (p=0.0001). Catheter dwell times for ≥5 days were also associated with increased recurrence (p=0.0001). Of the patients with recurrent strictures, 16, 18 and 22Fr catheters were placed in 22.22%, 20% and 57.78% of the patients, respectively. Increased catheter diameter was also associated with higher recurrence rates (p=0.004). Conclusion:Shortening the postoperative duration of catheterization and decreasing the catheter size may result in improved recurrence rates after DVIU. Further prospective randomized trials are necessary to confirm these findings.

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“…Thus multiple impairments of cellular responses contributed to non‐healing wounds during the wound healing process after urethroplasty, which make it a more complicated issue for success management of urethral stricture disease. Although the administration of anti‐fibrotic drugs like halofuginone has been proved to limit recurrence of urethral stricture, none of these medicines was observed with sufficient therapeutic benefit …”

Section: Introductionmentioning

confidence: 99%

“…Although the administration of anti-fibrotic drugs like halofuginone has been proved to limit recurrence of urethral stricture, none of these medicines was observed with sufficient therapeutic benefit. 6 Recently various strategies, including growth factors administration, gene therapy, and stem cell transplantation, have been used to improve the treatment of urethral stricture. 4,[7][8][9] Among these, the transplantation of mesenchymal stem cells (MSC)-the multipotent stromal progenitor cells-has been proved to enhance the tissue repair process and resulted in better performance.…”

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confidence: 99%

miR‐21 modification enhances the performance of adipose tissue‐derived mesenchymal stem cells for counteracting urethral stricture formation

Feng

Chen

et al. 2018

J Cellular Molecular Medi

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The treatment of complicated long segment strictures remains to a challenge, and the substitution urethroplasty treatment is often accompanied by subsequent tissue fibrosis and secondary stricture formation. In situ injection of human adipose tissue‐derived stem cells (hADSC) could potential be applied for prevention of urethral fibrosis, but the cells transplantation alone may be insufficient because of the complicated histopathological micro‐environmental changes in the injury site. This study investigated whether miR‐21 modification can improve the therapeutic efficacy of ADSCs against urethral fibrosis to limit urethral stricture recurrence. MiR‐21‐modified ADSCs (miR‐21) were constructed via lentivirus‐mediated transfer of pre‐miR‐21 and GFP reporter gene. In vitro results suggested that miR‐21 modification can increase the angiogenesis genes expression of ADSCs and enhance its anti‐oxidative effects against reactive oxygen species (ROS) damage. In vivo results showed that miR‐21 modification contributes to increased urodynamic parameters and better formation of the epithelium and the muscle layer as compared to ADSCs transplantation alone groups. The results demonstrated that miR‐21 modification in ADSCs could improve urethral wound healing microenvironment, enhance stem cell survival through ROS scavenging and promote the neovascularization via regulating angiogenic genes expression, which eventually increase the ADSCs' therapeutic potential for urethral wound healing.

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Prevention of Stricture Recurrence Following Urethral Endoscopic Management: What Do We Have?

Cited by 28 publications

References 61 publications

Which Factors Affect the Hospital Re-admission After Treatment Approaches to Urethral Strictures?

Which Factors Affect the Hospital Re-admission After Treatment Approaches to Urethral Strictures?

Catheter dwell time and diameter affect the recurrence rates after internal urethrotomy

miR‐21 modification enhances the performance of adipose tissue‐derived mesenchymal stem cells for counteracting urethral stricture formation

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