The treatment of complex urethral strictures using ventral onlay Buccal Mucosa Graft or ventral onlay penile Skin Island Flap urethroplasty: A prospective case series

Claassen, Frederik M.; Wentzel, S.

doi:10.1007/s12301-011-0015-1

Cited by 2 publications

(2 citation statements)

References 20 publications

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“…There has been a long tradition for treating such strictures with skin flaps [66,67], almost certainly driven by the need to use locally available material because of spinal anaesthesia. These have a relatively high long-term risk of stenosis at the junction with the native urethra, which is why buccal mucosa grafting of strictures of >2 cm has, more recently, become the norm in SSA [17,68,69]. These grafts may be inserted as primary reconstructions or as part of a staged procedure, the latter predominantly for the salvage of complications from previous hypospadias surgery [17,70].…”

Section: Operative Challenges In a Resource-poor Environmentmentioning

confidence: 99%

Male urethral stricture disease: why management guidelines are challenging in low‐income countries

et al. 2022

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Urethral stricture disease (USD) is one of the commonest urological pathologies in adult men in low-or low-middleincome countries, providing a significant work burden for the small number of specialist surgeons who are able to provide appropriate treatment. The underlying causes of anterior urethral stricture relate to urethral fibrosis from sexually transmitted infection, with posterior urethral disruption secondary to pelvic trauma being an equally common cause of USD in many countries in sub-Saharan Africa. Anterior urethral strictures are often long, and multifocal, and bulboprostatic disruptions are usually due to relatively low-velocity pelvic trauma. The management options available in resourcepoor settings are often severely limited by the individual's ability to pay for care, the availability of a specialist surgeon and, importantly, a shortage of functioning endoscopic equipment for less-invasive treatments. Consequently, reconstructive surgery is often regarded by the patient, and surgeon, as the most cost-effective and, therefore, primary means of treating a urethral stricture once urethral dilatation has failed. Regional anaesthetic techniques have limited the adoption of free-graft augmentation as an alternative to pedicled flaps of locally available skin for reconstruction, whilst an inability to provide tension-free bulbo-prostatic anastomoses has negatively impacted the outcome from the treatment of pelvic fracture disruption injuries in much of sub-Saharan Africa. However, Urolink has found that local surgeons can be taught sustainable skills required for successful complex urethroplasty when supported by longitudinal mentorship in the management of difficult clinical issues. Evidence-based practice is known to improve the standard of care in specific conditions in high-income countries, including the management of male USD. However, guidelines developed in highincome countries are not necessarily appropriate for stricture management in less well-resourced healthcare environments but could be adapted to help improve the delivery of stricture care for men in low-or low-middle income countries.

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Section: Operative Challenges In a Resource-poor Environmentmentioning

confidence: 99%

Male urethral stricture disease: why management guidelines are challenging in low‐income countries

et al. 2022

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“…These procedures can transiently improve urinary flow, but stricture recurrence is a major clinical problem [3]. According to the international guidelines, using buccal mucosa for open reconstruction is advised in the treatment of recurrent and complex urethral strictures [4,5,6]. The mechanism of stricture formation has not yet been completely elucidated and is likely multifactorial.…”

Section: Introductionmentioning

confidence: 99%

An Experimental Model of Urethral Stricture in Rabbits Using Holmium Laser under Urethroscopic Direct Visualization

Zhang

et al. 2014

Urol Int

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Objective: To establish an experimental rabbit model of urethral stricture using holmium laser under direct urethroscopic visualization. Methods: Sixteen adult male New Zealand rabbits were divided into equally-sized control and experimental groups. All rabbits underwent retrograde urethrography and transurethral endoscopy with a 7.5 F urethroscope after intramuscular anesthetic injection. We used a holmium:YAG laser to injure the distal urethra in all rabbits in the experimental group under direct visualization. Thirty days after surgery, all animals were evaluated with retrograde urethrography and urethroscopy. The flow rate of the isolated urethras was measured to evaluate urethral stricture formation. Results: One rabbit in the experimental group (12.5%) died of infection 4 days after surgery. Thirty days after surgery, retrograde urethrography and urethroscopy revealed strictures in all seven surviving rabbits (87.5%) in the experimental group. The mean flow rate of the isolated urethras was significantly lower in the experimental group than in the control group. Conclusion: A rabbit model of urethral stricture can be successfully established using holmium laser under direct urethroscopic visualization, providing an ideal object for research concerning the pathogenesis and molecular biology of urethral strictures.

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The treatment of complex urethral strictures using ventral onlay Buccal Mucosa Graft or ventral onlay penile Skin Island Flap urethroplasty: A prospective case series

Cited by 2 publications

References 20 publications

Male urethral stricture disease: why management guidelines are challenging in low‐income countries

Male urethral stricture disease: why management guidelines are challenging in low‐income countries

An Experimental Model of Urethral Stricture in Rabbits Using Holmium Laser under Urethroscopic Direct Visualization

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