It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two...It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent： 32 and 34 patients underwent single-stage （Duckett） or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months （20-60 months） and 35 months （18-60 months） in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure （18.75% vs 0%）. The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup （10.52%） than in the postpubescent cohort （46.15%）. These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.展开更多
Objective:To evaluate the functional results and complications of the lingual mucosal graft(LMG)urethroplasty and to sum up the current state of the art of this surgical technique.Methods:A systematic search of PubMed...Objective:To evaluate the functional results and complications of the lingual mucosal graft(LMG)urethroplasty and to sum up the current state of the art of this surgical technique.Methods:A systematic search of PubMed and Scopus electronic databases was performed,according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)statement.Studies involving male patients treated with LMG urethroplasty for urethral stricture were included.Complete protocol is available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080121.A meta-analysis comparing functional and long-term oral complication outcomes of LMG and buccal mucosal graft(BMG)was performed,calculating the odds ratio(OR)and 95%confidence interval(CI).Results:Twenty original articles were included in the qualitative analysis.Strictures of 1.5e16.5 cm have been treated with LMG urethroplasty,due to the improvement of harvesting technique and very low rate of long-term oral complications.Very good functional results have been reported by different authors for LMG urethroplasty,with lower rate of oral complications than BMG.The meta-analysis included six comparative studies involving 187 and 178 patients treated with LMG and BMG urethroplasty,respectively.An OR of 1.65(95%CI[0.95e2.87],I^2=0%)and 0.18(95%CI[0.03e1.26],I^2=68%)were found for LMG vs.BMG urethroplasty,in terms of success and oral complication rate,respectively.Conclusion:LMG urethroplasty can be reasonably considered a first choice technique for urethral stricture with very good results.Oral complications are temporary and minimally disabling,basically less than those for BMG,and depend mainly on the graft extent.展开更多
This study aimed to evaluate whether adding a vacuum erection device(VED)to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral in...This study aimed to evaluate whether adding a vacuum erection device(VED)to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury(PFUI).Altogether,78 PFUI patients with erectile dysfunction(ED)after primary posterior urethroplasty were enrolled and divided into two treatment groups:VED combined with Tadalafil(Group 1,n=36)and Tadalafil only(Group 2,n=42).Changes in penile length,testosterone level,International Index of Erectile Function-5(IIEF-5)questionnaire,Quality of Erection Questionnaire(QEQ),and nocturnal penile tumescence(NPT)testing were used to assess erectile function before and after 6 months of ED treatment.Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically(0.4±0.9 vs-0.8±0.7 cm,P<0.01).IIEF-5 score and QEQ score in Group 1 were higher than Group 2(both P<0.05).After treatment,21/36(5&3%)Group 1 patients and 19/42(45.2%)Group 2 patients could complete vaginal penetration.Group 1 patients also had markedly improved testosterone levels(P=0.01).Unexpectedly,there was no significant difference in NPT testing between two therapies.For PFUI patients with ED after posterior urethroplasty,the addition of VED to regular use of Tadalafil could significantly improve their conditions-improving erection and increasing penile length-thus increasing patient satisfaction and confidence in penile rehabilitation.展开更多
The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft （LMG） after failed hypospadias repairs. Inclusion ...The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft （LMG） after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years （range： 4-45 years）. Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients （group 1）, and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 （group 2）. The median LMG urethroplasty length was 5.6 ± 1.6 cm （range： 4-13 cm）. The mean follow-up was 34.7 months （range： 10-58 months）, and complications developed in 12 of 56 patients （21.4%）, including urethrocutaneous fistulas in 7 （6 in group 1, 1 in group 2） and neourethral strictures in 5 （4 in group 1, 1 in group 2）. The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient＇s age.展开更多
Long-segment lichen sclerosus(LS)urethral stricture is a challenge for urologists.Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty.In this retrospective stud...Long-segment lichen sclerosus(LS)urethral stricture is a challenge for urologists.Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty.In this retrospective study,we investigated the outcomes of these two procedures in patients with LS urethral stricture.Between January 2015 and December 2020,77 patients with LS urethral stricture underwent Kulkarni and Asopa procedures for urethroplasty in the Department of Urology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(Shanghai,China).Of the 77 patients,42(54.5%)underwent the Asopa procedure and 35(45.5%)underwent the Kulkarni procedure.The overall complication rate was 34.2%in the Kulkarni group and 19.0%in the Asopa group,and no difference was observed(P=0.105).Among the complications,no statistical difference was observed in the incidence of urethral stricture recurrence(P=0.724)or glans dehiscence(P=0.246)except for postoperative meatus stenosis(P=0.020).However,the recurrence-free survival rate between the two procedures was significantly different(P=0.016).Cox survival analysis showed that antiplatelet/anticoagulant therapy use(P=0.020),diabetes(P=0.003),current/former smoking(P=0.019),coronary heart disease(P<0.001),and stricture length(P=0.028)may lead to a higher hazard ratio of complications.Even so,these two techniques can still provide acceptable results with their own advantages in the surgical treatment of LS urethral strictures.The surgical alternative should be considered comprehensively according to the patient characteristics and surgeon preferences.Moreover,our results showed that antiplatelet/anticoagulant therapy use,diabetes,coronary heart disease,current/former smoking,and stricture length may be contributing factors of complications.Therefore,patients with LS are advised to undergo early interventions for better therapeutic effects.展开更多
This study aimed to assess the outcomes of modified onlay island flap(MOIF)urethroplasty for hypospadias reoperation.A retrospective analysis was conducted using clinical data on children reoperated with MOIF or tubul...This study aimed to assess the outcomes of modified onlay island flap(MOIF)urethroplasty for hypospadias reoperation.A retrospective analysis was conducted using clinical data on children reoperated with MOIF or tubularized incised plate(TIP)urethroplasty for hypospadias in the Children's Hospital of Nanjing Medical University(Nanjing,China)from December 2016 to September 2020.A total of 90 children with hypospadias who failed primary repair and were reoperated on with MOIF(MOIF group,n=46)or TIP urethroplasty(TIP group,n=44)were recruited.All children were postoperatively followed up for at least 6 months.Six patients with postoperative urinary fistula,2 patients with glans dehiscence,and 1 patient with urethral diverticulum were reported in the MOIF group,while 7 patients with postoperative urinary fistula,2 patients with urethral stricture,and 1 patient with glans dehiscence were reported in the TIP group.Postoperative infection,flap necrosis and other complications were not recorded.A total of 37(80.4%)patients in the MOIF group and 34(77.3%)patients in the TIP group were successfully reoperated.Although the success rates of MOIF and TIP urethroplasty are comparable,pediatricians should master different types of repair techniques for individualized hypospadias reoperation.MOIF urethroplasty can be recommended after failure of the primary repair.展开更多
Objective:To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty.Methods:We systematically searched for studies reporting the use of t...Objective:To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty.Methods:We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase(OvidSP)through January,1990 to June,2018.We excluded studies based on titles that clearly were not related to the subject,studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals,and in the absence of autologous cultured epithelial cells.Studies were also excluded if they were not published in English,had no disease background and adequate follow-up.Finally,we search all relevant abstract presented at two of the main urological meetings in the last 10 years:European Association of Urology(EAU)and American Urological Association(AUA).Results:A total of six articles,reporting the clinical use of tissue-engineered techniques in humans,were fully reviewed in our review.The epithelial cells were harvested from the urethra(10 patients),the bladder(11 patients)and the mouth(104 patients).The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases,and in adults for posterior and anterior urethral strictures repair in 109 cases.Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair.Conclusion:One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair.The studies demonstrate a high degree of heterogeneity respect to epithelial cells(from urethra,bladder,and mouth),type of scaffold,etiology,site of urethral stricture,number of patients,follow-up and outcomes.展开更多
Objective:Urethral stricture is a highly prevalent disease and has a continued ris-ing incidence.The global burden of disease keeps rising as there are significant rates of recur-rence with the existing management opt...Objective:Urethral stricture is a highly prevalent disease and has a continued ris-ing incidence.The global burden of disease keeps rising as there are significant rates of recur-rence with the existing management options with the need for additional repeat procedures.Moreover,the existing treatment options are associated with significant morbidity in the pa-tient.Long segment urethral strictures are most commonly managed by augmentation urethro-plasty.We explored the potential for the application of an acellular tissue engineered bovine pericardial patch in augmentation urethroplasty in a series of our patients suffering from ure-thral stricture disease.The decreased morbidity due to the avoidance of harvest of buccal mu-cosa,decreased operative time and satisfactory postoperative results make it a promising option for augmentation urethroplasty.Methods:Nine patients with long segment anterior urethral strictures(involving penile and/or bulbar urethra and stricture length>4 cm)were included in the study after proper informed consent was obtained.Acellular tissue engineered indigenous bovine pericardial patch was used for urethroplasty using dorsal onlay technique.Results:A total of nine patients underwent tissue engineered indigenous pericardial patch ur-ethroplasty for long segment urethral strictures,mostly catheter injury induced or associated with balanitis xerotica obliterans.Median follow-up was 8 months(range:2-12 months).Out of nine patients,eight(88.9%)were classifed as success and one(11.1%)was classified as fail-ure.Conclusion:Our study brings a product of tissue engineering,already being used in the cardio-vascular surgery domain,into the urological surgery operating room with satisfactory results achieved using standard operating techniques of one stage urethroplasty.展开更多
Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who...Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who underwent ventral onlay oral graft urethroplasty for bulbar strictures. Exclusion criteria were traumatic strictures, lichen sclerosus, failed hypospadias repair, failed urethroplasty, panurethral strictures, and incomplete medical charts. Pre-operative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, ultrasound and urethroscopy. Surgery was considered a failure when any post-operative instrumentation was needed. Median follow-up was 48 months. Out of 184 patients, 38 (20.7%) had not undergone previous treatment, 7 (3.8%) had undergone dilation, 81 (44%) DVIU and 58 (31.5%) DVIU associated with dilation. Out of 184 patients, 157 (85.3%) were successful and 27 (14.7%) failures. Out of 38 patients who had not undergone previous treatment, 33 (86.8%) were successful;out of 7 patients who had undergone dilation, 6 (85.7%) were successful;out of 81 patients who had undergone DVIU, 72 (88.9%) were successful;out of 58 patients who had undergone DVIU and dilation, 46 (79.3%) were successful. According to the number of previous DVIU, ventral graft urethroplasty for bulbar strictures showed high failure rate in patients who had undergone more than four DVIU associated or not with dilation.展开更多
Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patien...Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.展开更多
Urethrocutaneous fistula may complicate hypospadias repair.We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula.The aim...Urethrocutaneous fistula may complicate hypospadias repair.We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula.The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula.A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital(Amman,Jordan).Boys who were aged between 6 months and 5 years,diagnosed with distal hypospadias,and not circumcised were included.The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The results showed a total of 163 boys with distal hypospadias;among them,116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap,and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month,6 months,and 12 months(6.9%vs 0,10.3%vs 0,and 5.2%vs 0,respectively),and the difference after 6 months was statistically significant(P=0.02).展开更多
Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive tec...Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.Methods:From January 2016 to April 2018,17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study.The diagnosis of urethral stricture was confirmed based on a combination of patients’symptoms,post-void residual urine,video-urodynamics,and cystoscopy.Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection.Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score,post-void residual urine,and maximum flow rate.Results:Despite the previously failed minimally invasive procedures,urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes(success rateZ94%).The meanstandard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up(25.823.97 to 10.885.57);so did postvoid residual urine(71.1274.98 mL to 15.0028.30 mL),and maximum flow rate(7.881.72 mL/s to 25.825.59 mL/s)with all statistically significant(p<0.05).Conclusion:The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands.An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate.A laterally extended incision may improve visualization and better graft placement by providing wider working space.The results should be evaluated in the future studies with larger sample size.展开更多
Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclu...Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.展开更多
The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The c...The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.展开更多
Objective:The complexity of urethral strictures can predict outcomes following urethroplasty.The previously described urethral stricture score(U score)considered only stricture-related factors to grade the complexity ...Objective:The complexity of urethral strictures can predict outcomes following urethroplasty.The previously described urethral stricture score(U score)considered only stricture-related factors to grade the complexity of urethral strictures and to predict recurrence post urethroplasty,but not considered patient-related factors for the same.We aimed to study the correlation of both of these factors to the outcomes of oral mucosal graft urethroplasty.Methods:We retrospectively reviewed data of 101 patients who underwent oral mucosal graft urethroplasty in our institute with a minimum follow-up of 6 months.Baseline patient characteristics and stricture-related parameters were noted.The U score was calculated for all patients which consisted of the length,location,number,and etiology of stricture.Univariate and multivariate Cox proportional hazard regression models were used to determine significant risk factors of recurrence.Results:The mean follow-up of patients was 15 months.Recurrence was seen in 28 patients and the mean time for detection of recurrence was 8 months of follow-up.The Charlson Comorbidity Index,history of previous intervention,length of strictures,location of strictures,number of strictures,history of smoking,and etiology were independent predictors of recurrence following urethroplasty.Based on these parameters,we formulated the modified U score(MU score).The scores ranged from 0 to 6 and a score of>2 was found to be predictive of recurrence.On comparing receiver operating characteristic curves for both scores by the DeLong test,the MU score had larger area under the curve than the U score.Conclusion:The MU scoring system is the first of its kind attempt taking into consideration both patient-and stricture-related factors to predict recurrence following oral mucosal graft urethroplasty.展开更多
Objective:To evaluate the impact of a standardized antibiotic stewardship protocol on three subsequent endpoints in patients undergoing urethroplasty.Methods:Men undergoing bulbar substitution urethroplasty between Ja...Objective:To evaluate the impact of a standardized antibiotic stewardship protocol on three subsequent endpoints in patients undergoing urethroplasty.Methods:Men undergoing bulbar substitution urethroplasty between January 2009 and December 2016 were stratified by urine culture (UCx) at the time of surgery (sterile vs. non-sterile) and were subjected to a standardized algorithm for urinalysis and antimicrobial therapy. We performed quantitative and qualitative exploration of UCx results and the microbial spectrum. The ability of the algorithm to improve antibiotic stewardship was tested by three endpoints: (a) immediate (UCx 2 days postoperatively), (b) short-term (21-day infectious complications), and (c) long-term (retreatment-free survival [RFS]). Statistical analyses included bivariate comparisons. The Kaplan–Meier estimators were used to compare RFS between the groups. The multivariable Cox regression was used to evaluate the independent effect of UCx status at the time of surgery on RFS.Results:Of 374 men, 235 (63%) had a sterile and 139 (37%) a non-sterile culture at the time of surgery. The proportion of sterile cultures at the time of surgery (63%) was significantly improved to 82% 2 days postoperatively (p<0.001). There were 16 (4.3%) patients with infectious complications with no difference between patients with sterile versus non-sterile culture (p=0.6). At median follow-up of 29 months, there was no difference in RFS (84%) between patients with sterile versus non-sterile culture (p=0.3). Positive UCx was not a predictor of recurrence after multivariable adjustment (p=0.5).Conclusion:A standardized protocol such as the one introduced improves antibiotic stewardship through frequent testing and culture-specific treatment. This is crucial in avoiding unnecessary antimicrobial treatment, and reducing infectious events and adverse effects of a positive UCx on long-term stricture recurrence.展开更多
BACKGROUND Buccal mucosal graft urethroplasty is the gold standard treatment for urethral stricture disease.Toowoomba has obtained a fellowship trained urethroplasty surgeon who has been performing urethroplasties for...BACKGROUND Buccal mucosal graft urethroplasty is the gold standard treatment for urethral stricture disease.Toowoomba has obtained a fellowship trained urethroplasty surgeon who has been performing urethroplasties for the last two years.Patient reported outcome measure(PROM)questionnaires allow for a detailed and standardized analysis of success and morbidity post urethroplasty and can be used as a reference point against which urethral surgeons can benchmark their performance.AIM To assess whether patient compliance rates improved with the use of an abridged PROM questionnaire.METHODS Our database of urethroplasty patients was searched to identify patients who had completed the original PROM.This is routinely requested to be completed at the 3-,6-and 12-mo mark.All patients are asked to complete the questionnaire and to bring it back to their next appointment.Our original PROM consists of the international prostate symptom score,the sexual health index measure and the Global Response Assessment.An abridged version of the questionnaire was derived focusing on urinary flow,sexual function and overall quality of life and consisted of three questions.RESULTS Sixty-six patients were included in our study.Fifty-four patients had been invited to complete the original PROM with an overall compliance rate of 30%.Compliance rates improved to 91%with the introduction of the modified PROM.No correlation between non-compliance and patient factors were found.There was also no significant difference in patient reported quality of life when comparing urinary flow and sexual function.CONCLUSION We recommend the use of PROMs pre-and post-operatively to accurately determine the level of patient satisfaction.We acknowledge the aversion of patients in completing PROMs due to the length of these questionnaires.We propose a simplistic version aimed at the“Trifecta”of urethroplasty comprising of three questions focusing each on urinary flow,sexual function and quality of life.Our modified PROM demonstrated markedly improved compliance rates and can be used as a screening tool to identify patients who might have had a poor outcome and who require a more in-depth assessment.展开更多
<strong>Introduction:</strong> Penile skin flap urethroplasty is a technique for replacing or enlarging an obstructed urethra. We aim to report our experience in the practice of this surgical technique. &l...<strong>Introduction:</strong> Penile skin flap urethroplasty is a technique for replacing or enlarging an obstructed urethra. We aim to report our experience in the practice of this surgical technique. <strong>Patients and method:</strong> This was a prospective and descriptive study of penile skin flap urethroplasty indicated for urethral stenosis between January 2014 and December 2019. <strong>Results:</strong> A total of 21 penile skin flap urethroplasties for urethral stenosis were performed. The average age was 38.6 years old. The stenosis was of sclero-inflammatory origin in 15 cases (71.43%). It was of bulbo-perineal, penile, and penile-bulbar topography in about a third each. A history of urethral surgery was reported in 80.95% of the cases. The average length of the stenosis was 6.8 cm. Mundy circular skin flap urethroplasty about 15 cases (71.43%), and Quartey rectangular skin penile flap urethroplasty about 6 cases (28.57%) were the surgical techniques performed. The postoperative follow-up was favorable in 19 cases (90.48%). Two cases of urethral fistula (9.52%) underwent the 2<sup>nd</sup> urethroplasty. Urination at 1 year was satisfactory. No relapse has been reported to date. However, 4 patients (19.04%) reported asthenic ejaculation, and 1 patient (4.76%) a marked decrease in sexual pleasure. <strong>Conclusion:</strong> This surgical technique is effective in terms of voiding when the surgical indications are well chosen. The sexual aspect must be taken into account and the intervention only offered to those who really need it.展开更多
Background: Urethroplasty is the gold standard for treatment for urethral strictures. We describe our results of urethroplasty and analyse the risk factors associated with stricture recurrence and stricture-free survi...Background: Urethroplasty is the gold standard for treatment for urethral strictures. We describe our results of urethroplasty and analyse the risk factors associated with stricture recurrence and stricture-free survival. Methods: A retrospective review of urethroplasty surgery carried out from 2016-2022. Patient records were analysed to obtain demographics, clinical, pathological and outcome data. Success of surgery is defined as postoperative Qmax > 15 ml/s or absence of any instrumentation of urethra such as urethral dilatation, after removal of urethral indwelling catheter. Results: A total of 66 patients who fulfilled the inclusion criteria were selected. Mean age was 43.8. Mean follow up was 27.2 ± 21.8 months. Stricture recurred in 18 patients (27.3%). Estimated stricture free survival time was 59.6 months (95% CI: 50.87 - 68.37). Previous surgical history for stricture was found to be predictive of stricture recurrence. After adjusting for age, BMI, aetiology of stricture and stricture length, previous surgical history had a risk of stricture recurrence approximately three times higher compared to those without. Conclusion: Previous surgical intervention for urethral stricture was found to be the most significant factor for stricture recurrence. We strongly advocate that the first curative surgery done for urethral strictures should be done in high volume centres and by experienced reconstructive urologists.展开更多
Introduction: Urethroplasty remains the gold standard for the management of urethral stricture. However, the treatment of stricture disease in the elderly tends to be less invasive due to the presumption that they mig...Introduction: Urethroplasty remains the gold standard for the management of urethral stricture. However, the treatment of stricture disease in the elderly tends to be less invasive due to the presumption that they might not be able to stand long hours of surgery and might have higher rates of recurrence due to poor wound healing from microangiopathy. We present our experience with the outcomes of urethroplasty among elderly men seen at the Komfo Anokye Teaching Hospital from January 2012 to December 2021. Methods: This was a retrospective review of data captured in the urology database on all patients 65 years and above who underwent urethroplasty at the hospital over the study period. Data was obtained on patients’ demographics, stricture characteristics, urethroplasty technique, and outcome. A successful outcome was defined as peak flow rate > 15 mls/s, a patent urethra on retrograde urethrogram, patient satisfaction with urine stream, or restoration of the normal stream of urine with only one attempt at urethral calibration or internal urethrotomy postoperatively. Data was analyzed using PASW Statistics for Windows, Version 18.0. Results: Overall, 43 urethroplasties were done over the study period in elderly men. The age range was 65 to 87 years. The commonest aetiology was catheterization (62.79%) followed by urethritis (32.56%). Stricture length ranged from 0.5 cm to 16 cm with a mean of 3.93 cm. Most patients (60.46%) had bulbar urethral strictures. The repair methods employed were anastomotic urethroplasty (62.80%), fasciocutaneous flap (FCF) ventral onlay (13.95%), buccal mucosa graft (BMG) ventral onlay urethroplasty (4.65%), and staged urethroplasty (4.65%). Three of the patients (6.98%) had a combination of anastomotic and tissue transfer urethroplasty. The overall success rate was 88.37%. Complications included three surgical site infections, two urethral diverticula and one glans dehiscence. Conclusion: Elderly men tolerate urethroplasty well and the procedure should not be denied solely based on age.展开更多
文摘It is still debatable whether single- or two-stage urethroplasty is a more suitable technique for treating hypospadias with severe chordee after urethral plate transection. This retrospective study evaluated these two techniques. A total of 66 patients of proximal hypospadias with severe chordee were divided into two groups according to the techniques they underwent： 32 and 34 patients underwent single-stage （Duckett） or two-stage urethroplasty, respectively. Median ages at presentation were 7.5 years and 11.0 years in single-stage and two-stage repair groups, respectively. Median follow-ups were 28.5 months （20-60 months） and 35 months （18-60 months） in the single-stage and two-stage groups, respectively. The meatus of the neourethra was located at the top of the glans in all patients. No recurrence of chordee was found during follow-up, and all patients or parents were satisfied with the penile length and appearance. Complications were encountered in eight patients in both groups, with no statistically significant differences between the two techniques. The late complication rate of stricture was higher after the single-stage procedure （18.75% vs 0%）. The complication rate after single-stage repairs was significantly lower in the prepubescent subgroup （10.52%） than in the postpubescent cohort （46.15%）. These results indicate that the urethral plate transection effectively corrects severe chordee associated with proximal hypospadias during the intermediate follow-up period. Considering the higher rate of stricture after single-stage urethroplasty, two-stage urethroplasty is recommended for proximal hypospadias with severe chordee after urethral plate transection.
文摘Objective:To evaluate the functional results and complications of the lingual mucosal graft(LMG)urethroplasty and to sum up the current state of the art of this surgical technique.Methods:A systematic search of PubMed and Scopus electronic databases was performed,according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)statement.Studies involving male patients treated with LMG urethroplasty for urethral stricture were included.Complete protocol is available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080121.A meta-analysis comparing functional and long-term oral complication outcomes of LMG and buccal mucosal graft(BMG)was performed,calculating the odds ratio(OR)and 95%confidence interval(CI).Results:Twenty original articles were included in the qualitative analysis.Strictures of 1.5e16.5 cm have been treated with LMG urethroplasty,due to the improvement of harvesting technique and very low rate of long-term oral complications.Very good functional results have been reported by different authors for LMG urethroplasty,with lower rate of oral complications than BMG.The meta-analysis included six comparative studies involving 187 and 178 patients treated with LMG and BMG urethroplasty,respectively.An OR of 1.65(95%CI[0.95e2.87],I^2=0%)and 0.18(95%CI[0.03e1.26],I^2=68%)were found for LMG vs.BMG urethroplasty,in terms of success and oral complication rate,respectively.Conclusion:LMG urethroplasty can be reasonably considered a first choice technique for urethral stricture with very good results.Oral complications are temporary and minimally disabling,basically less than those for BMG,and depend mainly on the graft extent.
基金This study was supported,in part,by the National Natural Science Foundation of China(No.81671451)the Shanghai Key Laboratory of Forensic Medicine(Academy of Forensic Science,No.KF1915).
文摘This study aimed to evaluate whether adding a vacuum erection device(VED)to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury(PFUI).Altogether,78 PFUI patients with erectile dysfunction(ED)after primary posterior urethroplasty were enrolled and divided into two treatment groups:VED combined with Tadalafil(Group 1,n=36)and Tadalafil only(Group 2,n=42).Changes in penile length,testosterone level,International Index of Erectile Function-5(IIEF-5)questionnaire,Quality of Erection Questionnaire(QEQ),and nocturnal penile tumescence(NPT)testing were used to assess erectile function before and after 6 months of ED treatment.Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically(0.4±0.9 vs-0.8±0.7 cm,P<0.01).IIEF-5 score and QEQ score in Group 1 were higher than Group 2(both P<0.05).After treatment,21/36(5&3%)Group 1 patients and 19/42(45.2%)Group 2 patients could complete vaginal penetration.Group 1 patients also had markedly improved testosterone levels(P=0.01).Unexpectedly,there was no significant difference in NPT testing between two therapies.For PFUI patients with ED after posterior urethroplasty,the addition of VED to regular use of Tadalafil could significantly improve their conditions-improving erection and increasing penile length-thus increasing patient satisfaction and confidence in penile rehabilitation.
文摘The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft （LMG） after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years （range： 4-45 years）. Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients （group 1）, and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 （group 2）. The median LMG urethroplasty length was 5.6 ± 1.6 cm （range： 4-13 cm）. The mean follow-up was 34.7 months （range： 10-58 months）, and complications developed in 12 of 56 patients （21.4%）, including urethrocutaneous fistulas in 7 （6 in group 1, 1 in group 2） and neourethral strictures in 5 （4 in group 1, 1 in group 2）. The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient＇s age.
基金This work was supported by the Project of Shanghai Medical Innovation and Clinical Research(No.20Y11904300)the Clinical Research Project of Shanghai Municipal Health Commission(No.202040437).
文摘Long-segment lichen sclerosus(LS)urethral stricture is a challenge for urologists.Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty.In this retrospective study,we investigated the outcomes of these two procedures in patients with LS urethral stricture.Between January 2015 and December 2020,77 patients with LS urethral stricture underwent Kulkarni and Asopa procedures for urethroplasty in the Department of Urology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(Shanghai,China).Of the 77 patients,42(54.5%)underwent the Asopa procedure and 35(45.5%)underwent the Kulkarni procedure.The overall complication rate was 34.2%in the Kulkarni group and 19.0%in the Asopa group,and no difference was observed(P=0.105).Among the complications,no statistical difference was observed in the incidence of urethral stricture recurrence(P=0.724)or glans dehiscence(P=0.246)except for postoperative meatus stenosis(P=0.020).However,the recurrence-free survival rate between the two procedures was significantly different(P=0.016).Cox survival analysis showed that antiplatelet/anticoagulant therapy use(P=0.020),diabetes(P=0.003),current/former smoking(P=0.019),coronary heart disease(P<0.001),and stricture length(P=0.028)may lead to a higher hazard ratio of complications.Even so,these two techniques can still provide acceptable results with their own advantages in the surgical treatment of LS urethral strictures.The surgical alternative should be considered comprehensively according to the patient characteristics and surgeon preferences.Moreover,our results showed that antiplatelet/anticoagulant therapy use,diabetes,coronary heart disease,current/former smoking,and stricture length may be contributing factors of complications.Therefore,patients with LS are advised to undergo early interventions for better therapeutic effects.
文摘This study aimed to assess the outcomes of modified onlay island flap(MOIF)urethroplasty for hypospadias reoperation.A retrospective analysis was conducted using clinical data on children reoperated with MOIF or tubularized incised plate(TIP)urethroplasty for hypospadias in the Children's Hospital of Nanjing Medical University(Nanjing,China)from December 2016 to September 2020.A total of 90 children with hypospadias who failed primary repair and were reoperated on with MOIF(MOIF group,n=46)or TIP urethroplasty(TIP group,n=44)were recruited.All children were postoperatively followed up for at least 6 months.Six patients with postoperative urinary fistula,2 patients with glans dehiscence,and 1 patient with urethral diverticulum were reported in the MOIF group,while 7 patients with postoperative urinary fistula,2 patients with urethral stricture,and 1 patient with glans dehiscence were reported in the TIP group.Postoperative infection,flap necrosis and other complications were not recorded.A total of 37(80.4%)patients in the MOIF group and 34(77.3%)patients in the TIP group were successfully reoperated.Although the success rates of MOIF and TIP urethroplasty are comparable,pediatricians should master different types of repair techniques for individualized hypospadias reoperation.MOIF urethroplasty can be recommended after failure of the primary repair.
文摘Objective:To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty.Methods:We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase(OvidSP)through January,1990 to June,2018.We excluded studies based on titles that clearly were not related to the subject,studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals,and in the absence of autologous cultured epithelial cells.Studies were also excluded if they were not published in English,had no disease background and adequate follow-up.Finally,we search all relevant abstract presented at two of the main urological meetings in the last 10 years:European Association of Urology(EAU)and American Urological Association(AUA).Results:A total of six articles,reporting the clinical use of tissue-engineered techniques in humans,were fully reviewed in our review.The epithelial cells were harvested from the urethra(10 patients),the bladder(11 patients)and the mouth(104 patients).The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases,and in adults for posterior and anterior urethral strictures repair in 109 cases.Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair.Conclusion:One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair.The studies demonstrate a high degree of heterogeneity respect to epithelial cells(from urethra,bladder,and mouth),type of scaffold,etiology,site of urethral stricture,number of patients,follow-up and outcomes.
文摘Objective:Urethral stricture is a highly prevalent disease and has a continued ris-ing incidence.The global burden of disease keeps rising as there are significant rates of recur-rence with the existing management options with the need for additional repeat procedures.Moreover,the existing treatment options are associated with significant morbidity in the pa-tient.Long segment urethral strictures are most commonly managed by augmentation urethro-plasty.We explored the potential for the application of an acellular tissue engineered bovine pericardial patch in augmentation urethroplasty in a series of our patients suffering from ure-thral stricture disease.The decreased morbidity due to the avoidance of harvest of buccal mu-cosa,decreased operative time and satisfactory postoperative results make it a promising option for augmentation urethroplasty.Methods:Nine patients with long segment anterior urethral strictures(involving penile and/or bulbar urethra and stricture length>4 cm)were included in the study after proper informed consent was obtained.Acellular tissue engineered indigenous bovine pericardial patch was used for urethroplasty using dorsal onlay technique.Results:A total of nine patients underwent tissue engineered indigenous pericardial patch ur-ethroplasty for long segment urethral strictures,mostly catheter injury induced or associated with balanitis xerotica obliterans.Median follow-up was 8 months(range:2-12 months).Out of nine patients,eight(88.9%)were classifed as success and one(11.1%)was classified as fail-ure.Conclusion:Our study brings a product of tissue engineering,already being used in the cardio-vascular surgery domain,into the urological surgery operating room with satisfactory results achieved using standard operating techniques of one stage urethroplasty.
文摘Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who underwent ventral onlay oral graft urethroplasty for bulbar strictures. Exclusion criteria were traumatic strictures, lichen sclerosus, failed hypospadias repair, failed urethroplasty, panurethral strictures, and incomplete medical charts. Pre-operative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, ultrasound and urethroscopy. Surgery was considered a failure when any post-operative instrumentation was needed. Median follow-up was 48 months. Out of 184 patients, 38 (20.7%) had not undergone previous treatment, 7 (3.8%) had undergone dilation, 81 (44%) DVIU and 58 (31.5%) DVIU associated with dilation. Out of 184 patients, 157 (85.3%) were successful and 27 (14.7%) failures. Out of 38 patients who had not undergone previous treatment, 33 (86.8%) were successful;out of 7 patients who had undergone dilation, 6 (85.7%) were successful;out of 81 patients who had undergone DVIU, 72 (88.9%) were successful;out of 58 patients who had undergone DVIU and dilation, 46 (79.3%) were successful. According to the number of previous DVIU, ventral graft urethroplasty for bulbar strictures showed high failure rate in patients who had undergone more than four DVIU associated or not with dilation.
文摘Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.
文摘Urethrocutaneous fistula may complicate hypospadias repair.We noticed that double-layered preputial dartos flaps added to tubularized incised plate urethroplasty can reduce the risk of urethrocutaneous fistula.The aim of this study was to compare the outcomes of tubularized incised plate urethroplasty with double-layered preputial dartos flaps to with single-layered local fascial flaps in preventing urethrocutaneous fistula.A retrospective cohort study was conducted between January 2017 and December 2020 at Jordan University Hospital(Amman,Jordan).Boys who were aged between 6 months and 5 years,diagnosed with distal hypospadias,and not circumcised were included.The primary outcome was the occurrence of urethrocutaneous fistula in patients who underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The results showed a total of 163 boys with distal hypospadias;among them,116 patients underwent tubularized incised plate urethroplasty with a single-layered fascial flap,and 47 underwent tubularized incised plate urethroplasty with a double-layered fascial flap.The development of urethrocutaneous fistula was higher in the group receiving tubularized incised plate urethroplasty with a single-layered fascial flap than in the group receiving tubularized incised plate urethroplasty with a double-layered fascial flap after 1 month,6 months,and 12 months(6.9%vs 0,10.3%vs 0,and 5.2%vs 0,respectively),and the difference after 6 months was statistically significant(P=0.02).
文摘Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.Methods:From January 2016 to April 2018,17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study.The diagnosis of urethral stricture was confirmed based on a combination of patients’symptoms,post-void residual urine,video-urodynamics,and cystoscopy.Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection.Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score,post-void residual urine,and maximum flow rate.Results:Despite the previously failed minimally invasive procedures,urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes(success rateZ94%).The meanstandard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up(25.823.97 to 10.885.57);so did postvoid residual urine(71.1274.98 mL to 15.0028.30 mL),and maximum flow rate(7.881.72 mL/s to 25.825.59 mL/s)with all statistically significant(p<0.05).Conclusion:The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands.An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate.A laterally extended incision may improve visualization and better graft placement by providing wider working space.The results should be evaluated in the future studies with larger sample size.
文摘Objective:The objective of the study was to compare the outcome of tunica albuginea urethroplasty(TAU)and buccal mucosa graft(BMG)urethroplasty for anterior urethral stricture.Methods:Thirty patients who met the inclusion criteria were randomised into two groups:TAU(Group A)and BMG urethroplasty(Group B).Surgical outcome was evaluated with pre-and post-operative work-up involving retrograde urethrogram,voiding cystourethrogram,uroflowmetry,and urethroscopy.Patients were followed up till 1 year.Results:Mean duration of surgery was statistically significant between two groups(p=0.0005).Maximum urine flow rate was comparable when compared between two groups(p=0.22)but statistically significant when compared pre-and post-operatively(p<0.001).At follow-up of 1 year,the successful outcomes were 80% in Group A and 87%in Group B.A total of five patients who had unsuccessful results required redo urethroplasty.Complications were minimal in both the groups.Conclusion:TAU provides outcomes equivalent to those of BMG urethroplasty.TAU has less operative time,easy to perform,and beneficial in patients with poor oral hygiene.
文摘The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision(Mathieu-IP)versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis.The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology,Anhui Provincial Children’s Hospital(Hefei,China),from May 2019 to May 2022,were retrospectively analyzed.Thirty-eight patients underwent Mathieu-IP(Mathieu-IP group)and 32 underwent onlay island flap urethroplasty(Onlay group).Follow-ups at 1 month,6 months,and 12 months postoperatively assessed operative time,complications,urethral meatus morphology,and family satisfaction.The Mathieu-IP group had significantly shorter operative time(mean±standard deviation[s.d.]:81.58±5.18 min)versus the Onlay group(mean±s.d.:110.75±6.05 min;P<0.05).Surgical success rates were 78.9%(Mathieu-IP group)and 75.0%(Onlay group),with no significant difference(P>0.05).Complications were comparable between the groups.The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5%versus 13.8%in the Onlay group(P<0.05).Family satisfaction with general penile appearance and skin shape showed no significant differences,but the Mathieu-IP group had higher satisfaction with meatal position(P<0.05).Mathieu-IP offers simplicity,safety,and shorter operative time compared to Onlay.Both the techniques effectively treat urethral plate stenosis in distal hypospadias,with reduced postoperative complications compared to tubularized incised plate urethroplasty.Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream,indicating its potential for broader adoption.
文摘Objective:The complexity of urethral strictures can predict outcomes following urethroplasty.The previously described urethral stricture score(U score)considered only stricture-related factors to grade the complexity of urethral strictures and to predict recurrence post urethroplasty,but not considered patient-related factors for the same.We aimed to study the correlation of both of these factors to the outcomes of oral mucosal graft urethroplasty.Methods:We retrospectively reviewed data of 101 patients who underwent oral mucosal graft urethroplasty in our institute with a minimum follow-up of 6 months.Baseline patient characteristics and stricture-related parameters were noted.The U score was calculated for all patients which consisted of the length,location,number,and etiology of stricture.Univariate and multivariate Cox proportional hazard regression models were used to determine significant risk factors of recurrence.Results:The mean follow-up of patients was 15 months.Recurrence was seen in 28 patients and the mean time for detection of recurrence was 8 months of follow-up.The Charlson Comorbidity Index,history of previous intervention,length of strictures,location of strictures,number of strictures,history of smoking,and etiology were independent predictors of recurrence following urethroplasty.Based on these parameters,we formulated the modified U score(MU score).The scores ranged from 0 to 6 and a score of>2 was found to be predictive of recurrence.On comparing receiver operating characteristic curves for both scores by the DeLong test,the MU score had larger area under the curve than the U score.Conclusion:The MU scoring system is the first of its kind attempt taking into consideration both patient-and stricture-related factors to predict recurrence following oral mucosal graft urethroplasty.
文摘Objective:To evaluate the impact of a standardized antibiotic stewardship protocol on three subsequent endpoints in patients undergoing urethroplasty.Methods:Men undergoing bulbar substitution urethroplasty between January 2009 and December 2016 were stratified by urine culture (UCx) at the time of surgery (sterile vs. non-sterile) and were subjected to a standardized algorithm for urinalysis and antimicrobial therapy. We performed quantitative and qualitative exploration of UCx results and the microbial spectrum. The ability of the algorithm to improve antibiotic stewardship was tested by three endpoints: (a) immediate (UCx 2 days postoperatively), (b) short-term (21-day infectious complications), and (c) long-term (retreatment-free survival [RFS]). Statistical analyses included bivariate comparisons. The Kaplan–Meier estimators were used to compare RFS between the groups. The multivariable Cox regression was used to evaluate the independent effect of UCx status at the time of surgery on RFS.Results:Of 374 men, 235 (63%) had a sterile and 139 (37%) a non-sterile culture at the time of surgery. The proportion of sterile cultures at the time of surgery (63%) was significantly improved to 82% 2 days postoperatively (p<0.001). There were 16 (4.3%) patients with infectious complications with no difference between patients with sterile versus non-sterile culture (p=0.6). At median follow-up of 29 months, there was no difference in RFS (84%) between patients with sterile versus non-sterile culture (p=0.3). Positive UCx was not a predictor of recurrence after multivariable adjustment (p=0.5).Conclusion:A standardized protocol such as the one introduced improves antibiotic stewardship through frequent testing and culture-specific treatment. This is crucial in avoiding unnecessary antimicrobial treatment, and reducing infectious events and adverse effects of a positive UCx on long-term stricture recurrence.
文摘BACKGROUND Buccal mucosal graft urethroplasty is the gold standard treatment for urethral stricture disease.Toowoomba has obtained a fellowship trained urethroplasty surgeon who has been performing urethroplasties for the last two years.Patient reported outcome measure(PROM)questionnaires allow for a detailed and standardized analysis of success and morbidity post urethroplasty and can be used as a reference point against which urethral surgeons can benchmark their performance.AIM To assess whether patient compliance rates improved with the use of an abridged PROM questionnaire.METHODS Our database of urethroplasty patients was searched to identify patients who had completed the original PROM.This is routinely requested to be completed at the 3-,6-and 12-mo mark.All patients are asked to complete the questionnaire and to bring it back to their next appointment.Our original PROM consists of the international prostate symptom score,the sexual health index measure and the Global Response Assessment.An abridged version of the questionnaire was derived focusing on urinary flow,sexual function and overall quality of life and consisted of three questions.RESULTS Sixty-six patients were included in our study.Fifty-four patients had been invited to complete the original PROM with an overall compliance rate of 30%.Compliance rates improved to 91%with the introduction of the modified PROM.No correlation between non-compliance and patient factors were found.There was also no significant difference in patient reported quality of life when comparing urinary flow and sexual function.CONCLUSION We recommend the use of PROMs pre-and post-operatively to accurately determine the level of patient satisfaction.We acknowledge the aversion of patients in completing PROMs due to the length of these questionnaires.We propose a simplistic version aimed at the“Trifecta”of urethroplasty comprising of three questions focusing each on urinary flow,sexual function and quality of life.Our modified PROM demonstrated markedly improved compliance rates and can be used as a screening tool to identify patients who might have had a poor outcome and who require a more in-depth assessment.
文摘<strong>Introduction:</strong> Penile skin flap urethroplasty is a technique for replacing or enlarging an obstructed urethra. We aim to report our experience in the practice of this surgical technique. <strong>Patients and method:</strong> This was a prospective and descriptive study of penile skin flap urethroplasty indicated for urethral stenosis between January 2014 and December 2019. <strong>Results:</strong> A total of 21 penile skin flap urethroplasties for urethral stenosis were performed. The average age was 38.6 years old. The stenosis was of sclero-inflammatory origin in 15 cases (71.43%). It was of bulbo-perineal, penile, and penile-bulbar topography in about a third each. A history of urethral surgery was reported in 80.95% of the cases. The average length of the stenosis was 6.8 cm. Mundy circular skin flap urethroplasty about 15 cases (71.43%), and Quartey rectangular skin penile flap urethroplasty about 6 cases (28.57%) were the surgical techniques performed. The postoperative follow-up was favorable in 19 cases (90.48%). Two cases of urethral fistula (9.52%) underwent the 2<sup>nd</sup> urethroplasty. Urination at 1 year was satisfactory. No relapse has been reported to date. However, 4 patients (19.04%) reported asthenic ejaculation, and 1 patient (4.76%) a marked decrease in sexual pleasure. <strong>Conclusion:</strong> This surgical technique is effective in terms of voiding when the surgical indications are well chosen. The sexual aspect must be taken into account and the intervention only offered to those who really need it.
文摘Background: Urethroplasty is the gold standard for treatment for urethral strictures. We describe our results of urethroplasty and analyse the risk factors associated with stricture recurrence and stricture-free survival. Methods: A retrospective review of urethroplasty surgery carried out from 2016-2022. Patient records were analysed to obtain demographics, clinical, pathological and outcome data. Success of surgery is defined as postoperative Qmax > 15 ml/s or absence of any instrumentation of urethra such as urethral dilatation, after removal of urethral indwelling catheter. Results: A total of 66 patients who fulfilled the inclusion criteria were selected. Mean age was 43.8. Mean follow up was 27.2 ± 21.8 months. Stricture recurred in 18 patients (27.3%). Estimated stricture free survival time was 59.6 months (95% CI: 50.87 - 68.37). Previous surgical history for stricture was found to be predictive of stricture recurrence. After adjusting for age, BMI, aetiology of stricture and stricture length, previous surgical history had a risk of stricture recurrence approximately three times higher compared to those without. Conclusion: Previous surgical intervention for urethral stricture was found to be the most significant factor for stricture recurrence. We strongly advocate that the first curative surgery done for urethral strictures should be done in high volume centres and by experienced reconstructive urologists.
文摘Introduction: Urethroplasty remains the gold standard for the management of urethral stricture. However, the treatment of stricture disease in the elderly tends to be less invasive due to the presumption that they might not be able to stand long hours of surgery and might have higher rates of recurrence due to poor wound healing from microangiopathy. We present our experience with the outcomes of urethroplasty among elderly men seen at the Komfo Anokye Teaching Hospital from January 2012 to December 2021. Methods: This was a retrospective review of data captured in the urology database on all patients 65 years and above who underwent urethroplasty at the hospital over the study period. Data was obtained on patients’ demographics, stricture characteristics, urethroplasty technique, and outcome. A successful outcome was defined as peak flow rate > 15 mls/s, a patent urethra on retrograde urethrogram, patient satisfaction with urine stream, or restoration of the normal stream of urine with only one attempt at urethral calibration or internal urethrotomy postoperatively. Data was analyzed using PASW Statistics for Windows, Version 18.0. Results: Overall, 43 urethroplasties were done over the study period in elderly men. The age range was 65 to 87 years. The commonest aetiology was catheterization (62.79%) followed by urethritis (32.56%). Stricture length ranged from 0.5 cm to 16 cm with a mean of 3.93 cm. Most patients (60.46%) had bulbar urethral strictures. The repair methods employed were anastomotic urethroplasty (62.80%), fasciocutaneous flap (FCF) ventral onlay (13.95%), buccal mucosa graft (BMG) ventral onlay urethroplasty (4.65%), and staged urethroplasty (4.65%). Three of the patients (6.98%) had a combination of anastomotic and tissue transfer urethroplasty. The overall success rate was 88.37%. Complications included three surgical site infections, two urethral diverticula and one glans dehiscence. Conclusion: Elderly men tolerate urethroplasty well and the procedure should not be denied solely based on age.
