The Evolution of Urethroplasty for Bulbar Urethral Stricture Disease: Lessons Learned from a Single Center Experience

Granieri, Michael A.; Webster, George D.; Peterson, Andrew C.

doi:10.1016/j.juro.2014.05.085

Cited by 13 publications

(6 citation statements)

References 17 publications

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“…The success rates were 93.7% in 233 patients using a ventral onlay BMG. Recent series have demonstrated significantly lower recurrence rates using BMG over penile skin as a graft material for augmented anastomotic urethroplasty (5.8% vs. 21.6% over similar duration of follow-up) [53] .…”

Section: Anterior Urethral Stricturesmentioning

confidence: 99%

Current trends in urethral stricture management

Hillary

Osman

Chapple

2014

Asian Journal of Urology

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The recent International Consultation on Urological Disease (ICUD) panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis, as distinct from sphincter stenoses and a urethral disruption injury. Whenever possible, an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty. There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used, but clearly the extent of the spongiofibrosis and individual anatomical factors (the length of the penis and urethra) are important, the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee. More recently, there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique. Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps, as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results. It is important that the reconstructive surgeon is well versed in the full range of available repair techniques, as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.

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Section: Anterior Urethral Stricturesmentioning

confidence: 99%

Current trends in urethral stricture management

Hillary

Osman

Chapple

2014

Asian Journal of Urology

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“…The oldest known method of treatment is dilatation which is often palliative. [ 9 ] Over the years, the treatment has evolved[ 10 ] through urethrotomy and urethroplasty of various techniques. Often, the method used depends on the expertise of the urologist and the available tools.…”

Section: Introductionmentioning

confidence: 99%

A 10-year review of urethral stricture management in Irrua, Nigeria

Irekpita

2017

Niger J Surg

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Background:Several authors have demonstrated regional and temporal changes in the demographics of urethral stricture and its management.Objectives:To assess the changes in the demographics of the patients and the evolution of the management of urethral stricture in this institution.Subjects and Methods:This is a retrospective study. The files of all the men who were diagnosed with urethral stricture from May 2006 to April 2016 were retrieved from the database of the records department of the hospital. The predictor variables assessed included age at presentation, occupation, etiology, presenting symptoms, stricture site, length of stricture, treatment method, year of treatment, complications of treatment, result of urine microscopy and sensitivity, comorbidities, and social habits of the patients. The outcome variables were the proportion of men in relation to the predictor variables and the test of correlation (P = 0.05 and below significant). Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 21.Results:Forty-six patients were diagnosed as having urethral stricture within the study period. All were males. The mean age was 53.11 years (standard deviation 17.63852) with a range from 19 to 96. There were 4 (8.7%) students, 11 (23.9%) civil servants, 4 (8.7%) businessmen, 3 (6.5%) military men, and 24 (52.2%) others who were essentially artisans. Majority of them (68.9%) presented with lower urinary tract symptoms while Escherichia coli was the most commonly cultured organism from their urine (17.4%). The most common single etiology was urethritis (30.4%). From 2013 onward, there was an abrupt transition from conservative treatment using dilatation which dropped from 38.9% to 17.9%. More complex surgeries such as buccal mucosal graft urethroplasty for bulbar strictures and two-stage repair for penile strictures increased from 11.1% to 57.1%.Conclusion:Urethritis is still the most common single etiological factor in urethral stricture disease in this rural community. Artisans such as drivers and mechanics were the most commonly afflicted. There was an abrupt transition from the old conservative methods of treatment to complex urethroplasties within the study period.

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“…El tratamiento posterior a la recurrencia consistió en dilatación endoscópica o uretrotomía interna. 19 Fall y sus coautores (2014), en su estudio prospectivo y monocéntrico (2007-2010) de uretroplastias (anastomósica y de aumento) con 75 pacientes, evaluaron variables como: edad, circunstancias del diagnóstico, localización y longitud de la estenosis; causa y procedimientos uretrales anteriores; experiencia del personal en cirugía reconstructiva uretral y tipo de uretroplastia. Los resultados obtenidos mostraron que en 60% de los casos la causa más común dica, la uretroplastia anastomósica (escisión y anastomosis) implica la transección del cuerpo esponjoso y la escisión de la estenosis uretral, con la movilización distal y proximal de la uretra antes de realizar una anastomosis libre de tensión.…”

Section: Discussionunclassified

Recurrencia de la estenosis de uretra bulbar en pacientes con tratamiento primario de uretroplastia anastomósica o uretrotomía interna

Ortiz¹

2017

Rev Mex Urol

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ANTECEDENTES: la estenosis uretral reduce el flujo de orina y dificulta el vaciado vesical; su origen es multifactorial y no existe un consenso definitivo respecto de cómo se establecen el diagnóstico y el tratamiento definitivo.OBJETIVO: determinar la recurrencia de estenosis de uretra bulbar en pacientes con intervención quirúrgica primaria de uretroplastia anastomósica o uretrotomía interna.MATERIALES Y MÉTODOS: estudio de cohorte, retrospectivo, efectuado en pacientes a quienes se practicó uretroplastia anastomósica y uretrotomía interna, entre 2007 y 2014, en el Hospital General Dr. Manuel Gea González, Ciudad de México. Análisis de características preoperatorias: edad, retención urinaria, causa, longitud y localización del segmento estenósico; resultados pre y posquirúrgico de la uroflujometría (Qmax), recurrencia de la estenosis y tratamiento posterior a ésta.RESULTADOS: se registraron 31 (22.3%) pacientes a quienes se efectuó uretroplastia anastomósica y 108 uretrotomía interna (77.7%); la edad media fue de 54.12 ± 14.6 años y la causa más frecuente fue iatrogénica (57.6%), seguida del traumatismo (29.5%), idiopática (8.6%) e infecciosa (4.3%). La longitud media de la estenosis fue de 13.20 ± 4.9 mm; retención urinaria en 5.8%; Qmax prequirúrgico de 6.81 ± 1.53 y posquirúrgico de 11.78 ± 2.44 mL/seg. No se observó recurrencia a seis meses en los pacientes tratados mediante uretroplastia anastomósica y la recurrencia en los de uretrotomía interna fue de 43.9%. En los pacientes con recurrencia a 6 meses, el Qmax posquirúrgico fue 10.77 ± 1.82 vs 12.5 ± 2.59 mL/seg de quienes no tuvieron recurrencia (p=0.002).CONCLUSIONES: la uretroplastia anastomósica puede considerarse el tratamiento de primera línea en pacientes con estenosis de uretra bulbar ≤2 cm de longitud. La uretrotomía interna representa la técnica quirúrgica de mínima invasión de mayor disponibilidad para la práctica urológica.PALABRAS CLAVE: estenosis de uretra, estrechez uretral, uretroplastia anastomósica, uretrotomía interna.

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The Evolution of Urethroplasty for Bulbar Urethral Stricture Disease: Lessons Learned from a Single Center Experience

Cited by 13 publications

References 17 publications

Current trends in urethral stricture management

Current trends in urethral stricture management

A 10-year review of urethral stricture management in Irrua, Nigeria

Recurrencia de la estenosis de uretra bulbar en pacientes con tratamiento primario de uretroplastia anastomósica o uretrotomía interna

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