Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Prolonged Disease Duration

Hudak, Steven J.; Atkinson, Timothy; Morey, Allen F.

doi:10.1016/j.juro.2011.12.074

Cited by 73 publications

(59 citation statements)

References 15 publications

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“…There is some evidence that transurethral procedures are being used excessively and inappropriately because of their simplicity and ease of repetition, and because there is a lack of familiarity with urethroplasty . Transurethral procedures for strictures with unfavorable characteristics are not only futile, but can also complicate stricture characteristics by increasing tissue damage if they are repeated . It has been suggested that previous repeated transurethral procedures are associated with a higher failure rate of urethroplasty .…”

Section: Indications For Substitution Urethroplastymentioning

confidence: 99%

“…6,7 Transurethral procedures for strictures with unfavorable characteristics are not only futile, but can also complicate stricture characteristics by increasing tissue damage if they are repeated. 8 It has been suggested that previous repeated transurethral procedures are associated with a higher failure rate of urethroplasty. 9,10 For most patients with anterior urethral strictures for whom urethrotomy or dilation is inappropriate or in whom it has failed, urethroplasty is usually the only curative option and is the gold standard treatment.…”

Section: Indications For Substitution Urethroplastymentioning

confidence: 99%

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Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

Horiguchi

2017

Int J of Urology

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Male anterior urethral stricture is scarring of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen, decreasing the urinary stream. Its surgical management is a challenging problem, and has changed dramatically in the past several decades. Open surgical repair using grafts or flaps, called substitution urethroplasty, has become the gold standard procedure for anterior urethral strictures that are not amenable to excision and primary anastomosis. Oral mucosa harvested from the inner cheek (buccal mucosa) is an ideal material, and is most commonly used for substitution urethroplasty, and lingual mucosa harvested from the underside of the tongue has recently emerged as an alternative material with equivalent outcome. Onlay augmentation of oral mucosa graft on the ventral side (ventral onlay) or dorsal side (dorsal onlay, Barbagli procedure) has been widely used for bulbar urethral stricture with comparable success rates. In bulbar urethral strictures containing obliterative or nearly obliterative segments, either a two-sided dorsal plus ventral onlay (Palminteri technique) or a combination of excision and primary anastomosis and onlay augmentation (augmented anastomotic urethroplasty) are the procedures of choice. Most penile urethral strictures can be repaired in a one-stage procedure either by dorsal inlay with ventral sagittal urethrotomy (Asopa technique) or dorsolateral onlay with one-sided urethral dissection (Kulkarni technique); however, staged urethroplasty remains the procedure of choice for complex strictures, including strictures associated with genital lichen sclerosus or failed hypospadias. This article presents an overview of substitution urethroplasty using oral mucosa graft, and reviews current topics.

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Section: Indications For Substitution Urethroplastymentioning

confidence: 99%

Section: Indications For Substitution Urethroplastymentioning

confidence: 99%

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

Horiguchi

2017

Int J of Urology

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“…By incising the urethra via urethrotomy, the vascularity within the underlying corpus spongiosum might be destroyed during the procedure, which could exacerbate the ischemic spongiofibrosis and lead to the recurrence of stricture. In light of this, the place of DVIU in the treatment algorithm for male urethral stricture disease has been questioned (Heyns et al, 1998;Hudak et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

High-pressure balloon dilation for male anterior urethral stricture: single-center experience

Wang

et al. 2016

J. Zhejiang Univ. Sci. B

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Abstract:Objectives: We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation (HPBD) technique for anterior urethral stricture. Methods: From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy (DVIU). Patient demographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results: The operation time was much shorter for the HPBD procedure than for the DVIU ((13.19±2.68) min vs. (18.44±3.29) min, P<0.01). For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection (UTI) were less frequently encountered than those in DVIU (urethral bleeding: 2/31 vs. 8/25, P=0.017; UTI: 1/31 vs. 6/25 P=0.037). The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups (P=0.21, hazard ratio (HR)=0.65, 95% confidence interval (CI): 0.34 to 1.26). However, there was a significantly higher stricture-free survival in the HPBD group at 12 months (P=0.02, HR=0.35, 95% CI: 0.14 to 0.87), which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions: HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.

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“…4 Importantly, our reoperation rate was 20.6%, which is slightly higher than other large series and could be attributed to our utilization of the BMU in the setting of lichen sclerosis, failed urethroplasties and hypospadias repairs (33 patients), where urethral tissue quality was abnormal and the complexity of these repairs increased. 13 A large degree of spongiofibrosis was noted in our series, and could contribute to higher rates of stricture. Additionally, these patients were considered poor candidates for stricture excision and primary anastomosis because of the generalized length of the strictures, as well as the degree of spongiofibrosis.…”

Section: Discussionmentioning

confidence: 55%

Ventral onlay buccal mucosa urethroplasty: A 10‐year experience

Mellon

Bihrle

2013

Int J of Urology

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Objective: To report our experience, and to evaluate the long-term outcomes and complication profiles of ventral onlay buccal mucosal graft urethroplasty (BMU) after prior urological intervention. Methods: We retrospectively reviewed 114 consecutive patients between February 2001 and April 2009 who underwent buccal mucosal graft urethroplasty for recurrent anterior urethral stricture disease. Seven patients were excluded for incomplete data. The remaining 107 patients comprised the study cohort. The mean follow-up time was 39.3 months (range 6.6-127.3 months). All patients had prior urological attempts at operative management. Results: The mean stricture length was 3.14 cm (range 1.0-8.0 cm). Indications for buccal mucosal graft urethroplasty included: lichen sclerosis (2.8%), iatrogenic (24.3%), infection (4.7%) and perineal trauma/straddle injury (20.6%). Of these patients, 78 had bulbomembranous stricture disease, 20 had penile involvement and nine were multifocal strictures. The average number of prior urological procedures was 2.83 (range 1-9). The overall graft failure rate was 6.5%. Importantly, the re-operation rate was 20.6%, primarily for stricture recurrence (18), meatal stenosis (3) and urethral diverticulum. The mean time to complication was 10.8 months. Conclusions: Ventral onlay buccal mucosal graft urethroplasty offers satisfactory results in the setting of recurrent and complicated urethral stricture disease. Graft failures and complications generally occur within the first year after surgery. Bulbar strictures enjoy greater graft patency and lower complication rates than other stricture locations. In particular, guarded expectations should be given for stricture length >4 cm and multifocal disease.

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Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Prolonged Disease Duration

Abstract: Repeat transurethral manipulation of bulbar strictures is associated with increased stricture complexity and a marked delay to curative urethroplasty.

Cited by 73 publications

References 15 publications

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews

High-pressure balloon dilation for male anterior urethral stricture: single-center experience

Ventral onlay buccal mucosa urethroplasty: A 10‐year experience

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