To Transect or Not Transect: Results from the Scandinavian Urethroplasty Study, A Multicentre Randomised Study of Bulbar Urethroplasty Comparing Excision and Primary Anastomosis Versus Buccal Mucosal Grafting

Nilsen, Ole Jacob; Holm, Henriette Veiby; Ekerhult, Teresa Olsen; Lindqvist, Klas; Grabowska, Beata; Persson, Beata; Sairanen, Jukka

doi:10.1016/j.eururo.2021.12.017

Cited by 16 publications

(27 citation statements)

References 33 publications

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“…Nevertheless, many of these “negative” studies have shown non-significant trends favoring non-transection, and the most recent and largest of these cohorts by Chapman et al, did find significantly more de novo ED in the transecting group at the 6 month mark (14.3% vs. 4.3%, p = 0.008) [ 18 ]. Further, a 2022 randomized control trial published by Nilsen et al, showed significant increased complaints of penile shortening and decreased glans fullness during erections, albeit with similar IIEF-5 scores between the groups at 3 months and 12 months [ 16 ]. This is consistent with prior retrospective data showing increased complaint of penile shortening associated with EPA [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is not always well captured on existing patient reported outcomes, such as the International Index of Erectile Function (IIEF-5). A recent randomized trial addressed this gap by developing a novel outcome measure specific to urethroplasty with which they were able to detect significant differences in penile complications, including shortening and reduced glans filling, despite similar IIEF-5 scores between transecting and non-transecting groups ( Table 1 ) [ 16 ].…”

Section: Bulbar Urethroplasty: Transecting Vs Non-transecting Techniquesmentioning

confidence: 99%

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Non-Transecting Urethroplasty for Bulbar Urethral Strictures—Narrative Review and Treatment Algorithm

Coddington

Higgins

Mian

et al. 2022

JCM

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The bulbar urethra is the most common site of stricture disease for which urethroplasty remains standard of care. A decrease in trauma as an etiology in the developed world and concerns regarding sexual dysfunction related to transection of the corpus spongiosum have placed a renewed emphasis on non-transecting urethroplasty techniques. Here, we present our surgical algorithm with emphasis on non-transecting techniques for bulbar urethral stricture disease and review the current state of literature comparing transecting to non-transecting approaches in order to provide guidance to practitioners on patient selection, counseling, and technique.

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Section: Discussionmentioning

confidence: 99%

Section: Bulbar Urethroplasty: Transecting Vs Non-transecting Techniquesmentioning

confidence: 99%

Non-Transecting Urethroplasty for Bulbar Urethral Strictures—Narrative Review and Treatment Algorithm

Coddington

Higgins

Mian

et al. 2022

JCM

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“…This debate focuses on the benefits of preserving the antegrade blood supply to the corpus spongiosum. A recent random- ized controlled trial comparing excision and primary anastomosis (EPA) and buccal mucosa graft urethroplasty found a higher rate of reduced glans filling in the EPA group [29].…”

Section: Future Directionsmentioning

confidence: 99%

Testosterone, Urethral Vascularity, and Urethral Stricture Disease: A Review

Hammad¹,

Yafi²,

Barham³

2022

JOMH

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Urethral stricture disease is one of the oldest described urologic pathologies and urethroplasty is associated with high success rates. Many urethral strictures are thought to arise from iatrogenic injury or radiation therapy which can create ischemic insults to the urethra. In developed countries, most urethral strictures are idiopathic; therefore, much is still unknown about the etiology and pathogenesis of this disease. Testosterone is known to mediate vasculogenesis through vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1α (HIF-1α) pathways in various organs. Recently, testosterone has been shown to mediate urethral vasculogenesis. In the setting of testosterone deficiency, androgen supplementation can improve urethral vascularity. Further, there appears to be a high incidence of testosterone deficiency in men with urethral strictures. Despite many advances in our understanding of testosterone's association with the urethra over the past few years, there remains much to be learned about the mechanism of testosterone on urethral stricture etiology and whether testosterone deficiency and supplementation impact urethral reconstruction outcomes.

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“…In the first multicenter RCT between two different bulbar urethroplasty techniques, Nilsen et al . [ 23 ] randomized (1:1) men with bulbar urethral stricture of < 2 cm to either transecting excision and primary anastomosis (tEPA) ( n = 75) or buccal mucosa grafting (BMG) ( n = 76). At a 12-month follow-up, the tEPA group reported more penile complications ( P = 0.02), especially reduced glans filling ( P = 0.03) and shortening of penis ( P = 0.001).…”

Section: Sexual Dysfunction and Penile Complication After Transecting...mentioning

confidence: 99%

Roundup

Mandal

2022

Indian J Urol

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To Transect or Not Transect: Results from the Scandinavian Urethroplasty Study, A Multicentre Randomised Study of Bulbar Urethroplasty Comparing Excision and Primary Anastomosis Versus Buccal Mucosal Grafting

Cited by 16 publications

References 33 publications

Non-Transecting Urethroplasty for Bulbar Urethral Strictures—Narrative Review and Treatment Algorithm

Non-Transecting Urethroplasty for Bulbar Urethral Strictures—Narrative Review and Treatment Algorithm

Testosterone, Urethral Vascularity, and Urethral Stricture Disease: A Review

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