Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique From a Multi-institutional Surgical Outcomes Research Group

Cotter, Katherine; Hahn, Amy; Voelzke, Bryan B.; Myers, Jeremy B.; Smith, Thomas G.; Elliott, Sean P.; Alsikafi, Nejd F.; Breyer, Benjamin N.; Vanni, Alex J.; Buckley, Jill C.; Zhao, Lee C.; Broghammer, Joshua A.; Erickson, Beth

doi:10.1016/j.urology.2019.01.046

Cited by 37 publications

(22 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We utilized the TURNS urethroplasty database to identify patients with PFUI who underwent posterior urethroplasty. TURNS is a multi-institutional group focused on urologic trauma and reconstruction, made up of 13 urologic surgeon members, who have an established prospectively collected database of urethroplasty patients (20). The TURNS group has published their long-term voiding outcomes in 122 patients that underwent posterior urethroplasty following PFUI, with a success rate of 91% (6).…”

Section: Methodsmentioning

confidence: 99%

Sexual function following pelvic fracture urethral injury and posterior urethroplasty

Mazzone

Anderson²,

Voelzke

et al. 2021

Transl Androl Urol

Self Cite

View full text Add to dashboard Cite

Background: To evaluate erectile and sexual function after pelvic fracture urethral injury (PFUI) by performing a retrospective review of a large multi-center database. We hypothesized that most men will have erectile dysfunction (ED) and poor sexual function following PFUI, which will remain after posterior urethroplasty.Methods: Using the Trauma and Urologic Reconstructive Networks of Surgeons (TURNS) database, we identified PFUI patients undergoing posterior urethroplasty. We excluded patients with incomplete demographic, surgical and/or questionnaire data. Sexual Health Inventory of Men (SHIM), Male Sexual Health Questionnaire (MSHQ), and subjective changes in penile curvature were collected before urethroplasty surgery and at follow-up. We performed descriptive statistics for erectile and ejaculatory function using STATA v12.Results: We identified 92 men meeting inclusion criteria; median age was 41.7 years and BMI was 26.5. The mechanism of injury was blunt in all patients, and average distraction defect length was 2.3 cm (SD 1.0 cm).In the 38 patients who completed both pre and post-operative SHIM questionnaires, the mean SHIM score was 10.5 (SD 7.0), with 63% having severe ED (SHIM <12). The median follow-up was 5.6 months and the mean post-operative SHIM was 9.3 (SD 6.5), with 68% having severe ED. The mean change in SHIM score was −1.18 (SD 6.29) with 6 (16%) patients reporting de novo ED (≥5 point decrease in score). Of the men with pre-operative MSHQ data, 46/74 (62.1%) had difficulty with ejaculation, 25/35 (71%) had change in penile length, and 6/33 (18%) reported penile curvature. In men with post-operative MSHQ, 19/44 (43%) expressed difficulty with ejaculation, 23/32 (72%) had change in penile length, and 9/33 (27%) reported penile curvature.Conclusions: There is a high rate of severe ED, both following PFUI and remaining after posterior urethroplasty. Additionally, rates of ejaculatory difficulty and patient perceived changes in penile length and curvature underscore the complex nature of the impact of these injuries on sexual function beyond simple erectile function.

show abstract

Section: Methodsmentioning

confidence: 99%

Sexual function following pelvic fracture urethral injury and posterior urethroplasty

Mazzone

Anderson²,

Voelzke

et al. 2021

Transl Androl Urol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Due to the steep learning curve, questionably lower success rates and higher complication rates, this technique is much less common than it has been historically. 62 In many complex patients, local tissue including foreskin and penile skin have been exhausted or are of poor quality, limiting the applicability of flap techniques. In addition, as this technique has lost popularity there is a global lack of training for contemporary reconstructive urologists interested in learning classic techniques.…”

Section: Management Approachmentioning

confidence: 99%

Recurrent Anterior Urethral Stricture: Challenges and Solutions

Mershon¹,

Baradaran²

2021

RRU

View full text Add to dashboard Cite

Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment "failures". Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

show abstract

“…21,22 Urethral reconstruction may presently face challenges in research scope by availability of funding, willingness of patients or physicians to participate in various trials, difficulty in overcoming care by expert opinion, and an overall lack of evidence-based medicine. 23,24 The difficulty in amounting large case volumes to execute robust comparative trials is a particular challenge germane to reconstructive urology. 10,25 By identifying the emergent academic landscape of urethral reconstruction, this study informs the appropriate current emphasis on clinical judgment when managing urethral strictures in the absence of evidence-based guidelines.…”

Section: Commentmentioning

confidence: 99%

The Top 100 Cited Articles in Urethral Reconstruction

Lee

Ramstein

Cohen

et al. 2020

Urology

Self Cite

View full text Add to dashboard Cite

OBJECTIVE To examine the most cited literature in urethral reconstruction, review types of work published, and observe research trends. METHODS The Web of Sciences Sci-Expanded Index was used to conduct a search for urethral reconstruction. References were assessed for relevance to urethral reconstruction by 2 independent reviewers and a final list of the top 100 articles ranked by citation count was obtained. For each article, citation count, publication date, corresponding author, origin institution, origin country, topic area, study design, level of evidence, and origin journal were collected. RESULTS The mean citation count per publication was 108 (median = 94.5; range = 69-366, SD = 43) with a total of 10,874 citations for all papers since 1970. The top 100 articles were published between 1973 and 2011, came from 19 different countries and 16 different journals. Nearly half were case series and most studies were Level III evidence or lower. The United States was the largest contributor to the top 100 with 56 publications, followed by Italy (14), England (12), and Egypt (7). "Outcomes of surgical treatment for urethral stricture disease" was the most prevalent topic area comprising 55 articles in the top 100, with most articles including descriptions or outcomes of novel surgical techniques. CONCLUSION In this study, we discovered that the most cited literature in the field of urethral reconstruction is singularly focused and lacking in high levels of evidence. The top 100 cited articles originate primarily from the United States, focus on short-term outcomes after surgical treatment for urethral stricture disease, and are predominantly case series. UROLOGY 135: 139−145, 2020.

show abstract

Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique From a Multi-institutional Surgical Outcomes Research Group

Cited by 37 publications

References 23 publications

Sexual function following pelvic fracture urethral injury and posterior urethroplasty

Sexual function following pelvic fracture urethral injury and posterior urethroplasty

Recurrent Anterior Urethral Stricture: Challenges and Solutions

The Top 100 Cited Articles in Urethral Reconstruction

Contact Info

Product

Resources

About