|
1
|
Sarıkaya EA, Terzi S, Çakmak A, Özer MS, Şen V, Bozkurt O. Is it necessary to use a drain after urethroplastyby perineal approach if we can avoid complications by pressure dressing? BMC Urol 2025; 25:130. [PMID: 40389883 PMCID: PMC12087058 DOI: 10.1186/s12894-025-01768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Accepted: 04/01/2025] [Indexed: 05/21/2025] Open
Abstract
PURPOSE Peri-operative management of urethroplasty is yet to be standardized. One of the major obscure issues in perioperative management is the use of perineal drainage. Some reconstructive urologists prefer to use a drain as a routine while others never use one. Although the main purpose of drain placement is to prevent the collection and related wound complications, no study up-to-date refers to these complications neither with nor without drain usage. METHODS 152 consecutive patients who underwent urethroplastyvia perineal approach without perineal drain were included. Strict pressure dressing was applied to all patients. The presence of any perineal fluid collection, wound related complications and the need for re-operation for these complications were recorded. RESULTS Despite 42% of patients having a smoking history and other potential risk factors for wound related complications, there were no instances of fluid collection or wound dehiscence post-operatively. CONCLUSION Given the absolute absence of drainage related complications by applying only pressure dressing, we suggest that a perineal drain is not necessary after urethroplasty via perineal approach. Applying pressure dressing is an effective method to prevent fluid collection and related morbidities.
Collapse
Affiliation(s)
- Ege A Sarıkaya
- DokuzEylul University Hospital Urology Department, Izmir, Turkey.
| | - Sümeyye Terzi
- DokuzEylul University Hospital Urology Department, Izmir, Turkey
| | - Atahan Çakmak
- DokuzEylul University Hospital Urology Department, Izmir, Turkey
| | - M Selçuk Özer
- DokuzEylul University Hospital Urology Department, Izmir, Turkey
| | - Volkan Şen
- DokuzEylul University Hospital Urology Department, Izmir, Turkey
| | - Ozan Bozkurt
- DokuzEylul University Hospital Urology Department, Izmir, Turkey
| |
Collapse
|
|
2
|
Guo Y, Ma N, Wang M, Chen S, Liu P, Yang Z, Li Y. Comparing the tissue properties of human buccal mucosa and penile skin flap: insights for urethral graft substitution. World J Urol 2025; 43:137. [PMID: 39992424 DOI: 10.1007/s00345-025-05519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 02/13/2025] [Indexed: 02/25/2025] Open
Abstract
OBJECTIVES To compare the histological features, biomechanical properties, water permeability, and osmotic stress responses of human buccal mucosa and penile skin flaps to evaluate their suitability as urethral graft substitutes. METHODS Buccal mucosa (n = 53) and penile skin flap (n = 59) were prepared for histological assessment of tissue structural characteristics and vascular patterns using H&E staining and immunofluorescence. Biomechanical properties were evaluated through mechanical testing, water permeability through deuterium oxide diffusion assays, and osmotic stress responses under hypo-, iso-, and hypertonic conditions. RESULTS H&E staining revealed that the buccal mucosa epithelium was significantly thicker (628.8 ± 213.3 μm) than that of the penile skin flap (148.2 ± 62.1 μm; p < 0.05). Mechanical testing demonstrated that the buccal mucosa had significantly higher elastic modulus and tensile strength and lower tensile strain compared with penile skin flap (p < 0.05). Water permeability testing revealed that the cumulative diffusion of deuterium oxide (D2O) through the buccal mucosa was consistently higher at all time points compared to the penile skin flap (p < 0.05). In the Hypo group, the ratio of variation in epithelial thickness was significantly higher in the penile skin flap compared to the buccal mucosa. No statistical differences in the ratio of epithelial thickness variation were observed under Iso (p = 0.43) and Hyper (p = 0.07) conditions. The primary limitation of this study is the relatively small sample size. Additionally, the in vitro model lacks the ability to fully replicate the urethral microenvironment, where multiple interacting factors influence graft survival. CONCLUSION This study presents the first comprehensive comparison of the tissue properties of buccal mucosa and penile skin flaps. Our findings provide valuable insights for surgical decision-making, postoperative management, personalized treatment strategies, and the advancement of bioengineered urethral substitutes.
Collapse
Affiliation(s)
- Yilong Guo
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, NO. 33 Badachu Rd, Beijing, 100144, China
| | - Ning Ma
- Department of Hypospadias Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, NO. 33 Badachu Rd, Beijing, 100144, China
| | - Mengtong Wang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Beijing, 100020, China
| | - Sen Chen
- Department of Hypospadias Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, NO. 33 Badachu Rd, Beijing, 100144, China
| | - Pingping Liu
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, NO. 33 Badachu Rd, Beijing, 100144, China
| | - Zhe Yang
- Department of Hypospadias Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, NO. 33 Badachu Rd, Beijing, 100144, China
| | - Yangqun Li
- Department of Comprehensive Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, NO. 33 Badachu Rd, Beijing, 100144, China.
| |
Collapse
|
|
3
|
Barasa P, Simoliunas E, Grybas A, Zilinskaite-Tamasauske R, Dasevicius D, Alksne M, Rinkunaite I, Buivydas A, Baltrukonyte E, Tamulyte R, Megur A, Verkauskas G, Baltriukiene D, Bukelskiene V. Development of multilayered artificial urethra graft for urethroplasty. J Biomed Mater Res A 2025; 113:e37796. [PMID: 39268589 DOI: 10.1002/jbm.a.37796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/11/2024] [Accepted: 09/03/2024] [Indexed: 09/17/2024]
Abstract
To enhance the treatment of patients' urethral defects, such as strictures and hypospadias, we investigated the potential of using artificial urethral tissue. Our study aimed to generate this tissue and assess its effectiveness in a rabbit model. Two types of bioprinted grafts, based on methacrylated gelatin-silk fibroin (GelMA-SF) hydrogels, were produced: acellular, as well as loaded with autologous rabbit stem cells. Rabbit adipose stem cells (RASC) were differentiated toward smooth muscle in the GelMA-SF hydrogel, while rabbit buccal mucosa stem cells (RBMC), differentiated toward the epithelium, were seeded on its surface, forming two layers of the cell-laden tissue. The constructs were then reinforced with polycaprolactone-polylactic acid meshes to create implantable multilayered artificial urethral grafts. In vivo experiments showed that the cell-laden tissue integrated into the urethra with less fibrosis and inflammation compared to its acellular counterpart. Staining to trace the implanted cells confirmed integration into the host organism 3 months postsurgery.
Collapse
Affiliation(s)
- Povilas Barasa
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Egidijus Simoliunas
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Aivaras Grybas
- Urology Center, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Ramune Zilinskaite-Tamasauske
- Children's Surgery, Orthopaedic and Traumatology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Darius Dasevicius
- Centre of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Milda Alksne
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Ieva Rinkunaite
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Andrius Buivydas
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Emilija Baltrukonyte
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Rimgaile Tamulyte
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | | | - Gilvydas Verkauskas
- Children's Surgery, Orthopaedic and Traumatology Centre, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Daiva Baltriukiene
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Virginija Bukelskiene
- Institute of Biochemistry, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
|
4
|
Gite VA. Editorial Comment. Indian J Urol 2024; 40:259. [PMID: 39555436 PMCID: PMC11567572 DOI: 10.4103/iju.iju_308_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2024] Open
Affiliation(s)
- Venkat Arjunrao Gite
- Department of Urology, Government Medical College and Superspeciality Hospital, Chatrapati Sambhaji Nagar, Aurangabad, Maharashtra, India
| |
Collapse
|
|
5
|
Zhao X, Guo Q, Zhang X, Xing Q, Ren S, Song Y, Li C, Hao C, Wang J. The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis. Sex Med 2024; 12:qfae064. [PMID: 39315305 PMCID: PMC11416911 DOI: 10.1093/sexmed/qfae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/24/2024] [Accepted: 09/10/2024] [Indexed: 09/25/2024] Open
Abstract
Background The urinary and sexual outcomes after urethroplasty may be a concern for patients, but there are still some controversies regarding the consequences of buccal mucosal graft urethroplasty (BMG) in terms of erectile dysfunction (ED). Aim This meta-analysis aimed to compare urinary and sexual outcomes of BMG and end-to-end urethroplasty (EE). Methods The PubMed, Web of Science, Cochrane, and Embase databases were searched until February 31, 2023. Data extraction and quality assessment were performed by 2 designated researchers. Dichotomous data were analyzed as odds ratios with 95% confidence intervals (CIs). Heterogeneity across studies was assessed by the I2 quantification, and publication bias using Begg's and Egger's tests. Meta-analysis was performed using RevMan software. Outcomes Outcomes included stricture recurrence, ED, penile complications, and voiding symptoms. Results Eighteen studies, including 1648 participants, were included in our meta-analysis. The meta-analysis revealed that there was no significant difference in stricture recurrence (OR = 0.74; 95% CI, 0.48-1.13; P = .17) and voiding symptoms (OR = 1.12; 95% CI, 0.32-3.88; P = .86) between the BMG group and the EE group. BMG was associated with lower risk of penile complications (OR = 0.40; 95% CI, 0.24-0.69; P = .001) and ED (OR = 0.53, 95% CI, 0.32-0.90, P = .02). Clinical Implications The study may help clinicians choose procedures that achieve better recovery of the urological and sexual function in the treatment of urethral stricture. Strengths and Limitations This meta-analysis is the first to evaluate the urinary and sexual outcomes of BMG vs EE. A limitation is that most of the included studies were retrospective cohort studies. Conclusion BMG is as effective as EE in the treatment of bulbar urethral stricture, but BMG has fewer complications and ED than EE.
Collapse
Affiliation(s)
- Xingming Zhao
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| | - Qiang Guo
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| | - Xi Zhang
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| | - Qi Xing
- Department of Urology, Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| | - Sheng Ren
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| | - Yuting Song
- Department of Histology and Embryology, Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| | - Chengyong Li
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| | - Chuan Hao
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| | - Jingqi Wang
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province 030001, China
| |
Collapse
|
|
6
|
Salimi H, Hosseini J, Sharifian R, Fallah Karkan M, Namiranian N, Injinari N, Ahmadi Basiri E, Abouei S, Samadaeegelehkolaee K, Mirjalili A. The Effect of Botulinum Toxin (Masport) Injection Following Internal Urethrotomy of Bulbar Urethral Stricture: A Pilot Study. Am J Mens Health 2024; 18:15579883241271279. [PMID: 39183387 PMCID: PMC11345732 DOI: 10.1177/15579883241271279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/31/2024] [Accepted: 06/25/2024] [Indexed: 08/27/2024] Open
Abstract
The application of Botulinum toxin (Masport) in urology has a long history. We aimed to assess the effect of local Masport on improvement in patients with urethral stricture by reducing the recurrence of urethral stricture. This pilot study conducted was a double-blind randomized clinical trial with code IRCT20191222045852N1 on patients suffering from urethral stricture. Finally, 28 patients were allocated to intervention and control groups. Twelve patients received intralesional injection with Masport in addition to internal urethrotomy, while 16 patients underwent internal urethrotomy with normal saline. The Cox regression hazard model was used to evaluate the effect of treatment status on recurrence time adjusted for the age, length, and location of the stenosis, cause of the stenosis, and history of previous operations. The effect of treatment type was significant at the .05 level. The past medical history and cause of urethral stricture had a significant impact on relapse-free survival. Also, the improvement in the mean score of the EuroQol Visual Analogue Scale (EQ-VAS), International Prostate Symptom Score (IPSS), and Q-max in the group with Masport was significantly different from the group with normal saline. The internal urethrotomy with intralesional injection of Masport has a better survival prognosis than internal urethrotomy with normal saline group. Therefore, the authors suggest that, given this successful initial clinical trial, consideration be given to future studies involving the use of botox in the management of urethral strictures in conjunction with internal urethrotomy.
Collapse
Affiliation(s)
- Hojat Salimi
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalil Hosseini
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rayka Sharifian
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Fallah Karkan
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasim Namiranian
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nastaran Injinari
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elham Ahmadi Basiri
- Trauma and Surgery Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Saeid Abouei
- Medical Doctor, Research Committee, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Keshvar Samadaeegelehkolaee
- Sexual and Reproductive Health Research Center, Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alimohammad Mirjalili
- Reconstructive Urologist, Yazd Urology Department, Men’s Health, and Reproductive Health Research Center, Yazd, Iran
| |
Collapse
|
|
7
|
Isali I, Wong TR, Wu CHW, Scarberry K, Gupta S, Erickson BA, Breyer BN. Genomic Risk Factors for Urethral Stricture: A Systematic Review and Gene Network Analysis. Urology 2024; 184:251-258. [PMID: 38160764 DOI: 10.1016/j.urology.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/14/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To identify genes that may play a role in urethral stricture and summarize the results of studies that have documented variations in gene expression among individuals with urethral stricture compared to healthy individuals. METHODS A systematic search was conducted in Cochrane, Ovid, Web of Science, and PubMed, limiting the results to articles published between January 1, 2000 and January 30, 2023. Only studies comparing the difference in gene expression between individuals with urethral stricture and healthy individuals utilizing molecular techniques to measure gene expression in blood, urine, or tissue samples were included in this systematic review. Gene network and pathway analyses were performed using Cytoscape software, with input data obtained from our systematic review of differentially expressed genes in urethral stricture. RESULTS Four studies met our criteria for inclusion. The studies used molecular biology methods to quantify gene expression data from specimens. The analysis revealed gene expressions of CXCR3 and NOS2 were downregulated in urethral tissue samples, while TGFB1, UPK3A, and CTGF were upregulated in plasma, urine and urethral tissue samples, respectively, in patients with urethral stricture compared to healthy controls. The analysis demonstrated that the most significant pathways were associated with phosphoinositide 3-kinase (PI3 kinase) and transforming growth factor beta 1/suppressor of mothers against decapentaplegic (TGF-β1/SMAD) signaling pathways. CONCLUSION This systematic review identified gene expression variations in several candidate genes and identified underlying biological pathways associated with urethral stricture. These findings could inform further research and potentially shift treatment and prevention strategies for urethral stricture.
Collapse
Affiliation(s)
- Ilaha Isali
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Thomas R Wong
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Chen-Han Wilfred Wu
- Department of Urology, Case Western Reserve University, Cleveland, OH; Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH
| | - Kyle Scarberry
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | | | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
| |
Collapse
|
|
8
|
Gundogdu G, Nguyen T, Eijansantos M, Chaudhuri A, Barham D, Gelman J, Mauney JR. Development of male and female models of long urethral strictures in swine. Surg Open Sci 2023; 16:205-214. [PMID: 38035225 PMCID: PMC10687041 DOI: 10.1016/j.sopen.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
Background Preclinical animal models which mimic the dimensions of long urethral strictures (>2 cm in length) encountered in the clinic are necessary to evaluate prospective graft designs for urethroplasty. The purpose of this study was to develop both male and female porcine models of long urethral strictures (∼4 cm in length) and characterize histological and functional outcomes of iatrogenic stricture formation between genders. Methods Focal, partial thickness urethral injuries were created over 5-6 cm long segments in male and female swine (N = 4 per gender) via electrocoagulation and the degree of stricture formation was monitored for up to 6 weeks by urethroscopy and retrograde urethrography. Animals were sacrificed following stricture confirmation and histological, immunohistochemical, and histomorphometric analyses were performed on strictured and uninjured control urethral segments to profile wound healing responses. Results Urethral stricture formation was detected in all female swine by 2 weeks and 100 % of male swine at 3.2 ± 1.8 weeks, post-operatively. The mean length of urethral strictures in both male and female swine was ∼4 cm. Substantial variations in the degree of stricture severity between sexes were observed with males exhibiting significant urethral stenosis and loss of α-smooth muscle actin+ smooth muscle bundles in comparison to controls, while females primarily displayed defects in pan-cytokeratin+ epithelia as well as functional urethral obstruction. Conclusions Electrocoagulation injury is sufficient to produce long urethral strictures in male and female swine and the degree of stricture severity and nature of urethral obstruction was observed to be dependent on gender. Animal Protocol: AUP-19-150. Key message Novel male and female models of long urethral strictures in swine were created to characterize histological and functional outcomes of iatrogenic stricture formation between genders.
Collapse
Affiliation(s)
- Gokhan Gundogdu
- Department of Urology, University of California, Irvine, Orange, CA 92868, USA
| | - Travis Nguyen
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92617, USA
| | - Mando Eijansantos
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92617, USA
| | - Ambika Chaudhuri
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92617, USA
| | - David Barham
- Department of Urology, University of California, Irvine, Orange, CA 92868, USA
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, CA 92868, USA
| | - Joshua R. Mauney
- Department of Urology, University of California, Irvine, Orange, CA 92868, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92617, USA
| |
Collapse
|
|
9
|
Akyuz M, Ozsoy E, Tokuc E, Artuk I, Kayar R, Bastug Y, Öztürk Mİ. Management and outcomes of urethral stricture: single centre experience over 13 years. Aktuelle Urol 2023; 54:482-486. [PMID: 36002031 DOI: 10.1055/a-1904-6943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AIM To present a comprehensive summary of the diagnosis, treatment and follow-up process of patients who underwent open urethroplasty in our tertiary referral center for the treatment of urethral stricture in the last 13 years. MATERIALS AND METHODS Two hundred and forty-five (245) patients who underwent open urethroplasty between January 2008 and June 2021 were retrospectively analysed. Detailed history, physical examination, uroflowmetry, retrograde urethrography and/or voiding cystourethrography and/or urethroscopy were used throughout the preoperative diagnosis process. While evaluating the postoperative patency rates, the absence of preoperative voiding symptoms after the operation and Qmax 15 ml/sec and above were taken into account. RESULTS Mean stricture length was 3.8 +/- 1.4 cm. Transurethral endoscopic interventions in 79 patients (32.2%), catheterisation in 55 patients (22.4%), trauma in 54 patients (22%), infection in 15 patients (6.2%), and idiopathology in 42 patients (17.2%) were the causes for the stricture. Buccal mucosal graft was used in 125 patients (51%), penile skin flap in 32 patients (13%), end-to-end anastomosis in 83 patients (33.8%) and Heineke-Mikulicz technique in 5 patients (2%). Mean follow-up period was 67.1 +/- 28.9 months. Success rates of patients were 84% (105) in buccal mucosal graft, 78.1% (25) in penile skin flap, 86.7% (72) with end-to-end anastomosis and 80% (4) with Heineke-Mikulicz technique. CONCLUSION Among treatment options for urethral stricture, urethroplasty techniques is the most successful treatment. Consideration of the factors leading to the formation of the stricture, with the intraoperative findings and surgical experience will maximize the benefit the patient receives.
Collapse
Affiliation(s)
- Mehmet Akyuz
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Emrah Ozsoy
- Urology, Ünye Çakırtepe Hospital, Ordu, Turkey
| | - Emre Tokuc
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ilker Artuk
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ridvan Kayar
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Bastug
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Metin İshak Öztürk
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
|
10
|
Özsoy E, Kutluhan MA, Tokuç E, Artuk İ, Kayar R, Akyüz M, Öztürk Mİ. Predictive value of systemic immune-inflammation index in recurrent urethral strictures. Urologia 2023; 90:510-515. [PMID: 36321780 DOI: 10.1177/03915603221132033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE To investigate the predictive value of systemic immune-inflammation index (SII) in recurrence of urethral stricture in patients undergoing internal urethrotomy. METHODS In this two-center, retrospective study, 703 patients who had internal urethrotomy for urethral stricture were included. Demographic, clinical, and laboratory characteristics and operative data were obtained. Two groups were formed from the patients as non-recurrent urethral stricture (n = 490) and recurrent urethral stricture (n = 213). RESULTS There was no significant difference in the mean age between the patients with and without recurrence. There was a significant difference in the mean SII values and albumin levels between the recurrence and non-recurrence groups (p = 0.001 and p = 0.006, respectively). Using a cut-off value of 252 for the SII; the sensitivity was 59.62%, the specificity was 70.41%, the positive predictive value was 46.69%, the negative predictive value was 80.05% and the accuracy was 67.14%, respectively. Statistically significant correlation was found between the presence of recurrence and the established cut-off value of the SII (p = 0.001 and p < 0.01, respectively). The risk of recurrence was stated that 3.514 times higher in patients with a SII value of ⩾252. CONCLUSION Using the SII the inflammatory state of the urethral tissue can be evaluated. Thus the risk of recurrence after internal urethrotomy operation can be predicted. Open urethroplasty technique instead of DVIU in patients with high SII values may increase the surgical success rates.
Collapse
Affiliation(s)
| | - Musab Ali Kutluhan
- Department of Urology, Yildirim Beyazit University School of Medicine, Ankara
| | - Emre Tokuç
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - İlker Artuk
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Rıdvan Kayar
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Akyüz
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| | - Metin İshak Öztürk
- Department of Urology, Health Sciences University Haydarpasa Numune Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
|
11
|
Barnard J, Liaw A, Gelman J. Long-term follow-up suggests high satisfaction rates for bulbomembranous radiation-induced urethral stenoses treated with anastomotic urethroplasty. World J Urol 2023; 41:1905-1912. [PMID: 37314572 PMCID: PMC10352169 DOI: 10.1007/s00345-023-04429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/18/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE To analyze patients who underwent anastomotic urethroplasty for radiationinduced bulbomembranous urethral stricture/stenosis (RIS) due to prostate cancer treatment with up to 19 years of follow-up and assess long-term patient reported outcomes (PROMs). Long-term follow-up with the inclusion of urethroplasty specific PROMs is lacking in the available research. METHODS Patients who underwent anastomotic urethroplasty for RIS were identified from 2002 to 2020. Inclusion criteria included completion of 4-month post-operative cystoscopy and PROMs including IPSS, SHIM, MSHQ-EF, 6Q-LUTS, and global satisfaction queries at 4 months. PROMs were assessed annually thereafter, and cystoscopy was performed for adverse change in PROMs or worsening uroflow/PVR parameters. PROMs were compared at pre-op, post-op, and most recent follow-up. RESULTS 23 patients met inclusion criteria. Short-term anatomic success was 95.7%. At a mean follow-up of 73.1 months (9.1-228.9), one late recurrence occurred for an overall success of 91.3%. Significant and sustained objective improvement was identified in voiding scores, quality of life, and urethroplasty specific PROMs. Satisfaction was 91.3% despite sexual side effects, and 95.7% of patients stated they would have surgery again knowing their outcome at a mean of over 6 years' follow up. CONCLUSIONS RIS are challenging problems, but durable symptomatic relief is achievable in well-selected patients. Patients with bulbomembranous RIS should be appropriately counseled regarding the risk of urinary incontinence and sexual side effects after anastomotic urethroplasty. However, long-term success is high, and overall QoL will have sustained subjective improvement in most cases.
Collapse
Affiliation(s)
- John Barnard
- West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Aron Liaw
- University of California-Irvine, Irvine, CA, USA
| | | |
Collapse
|
|
12
|
Ha JY, Lee MS. Interventional urethral balloon dilatation before endoscopic visual internal urethrotomy for post-traumatic bulbous urethral stricture: A case report. World J Clin Cases 2022; 10:12787-12792. [PMID: 36579103 PMCID: PMC9791538 DOI: 10.12998/wjcc.v10.i34.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/22/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND While several treatment options are available for pediatric urethral strictures, the appropriate treatment must be based on several factors. Although endoscopic visual internal urethrotomy (EVIU) could be a first-line treatment option for short pediatric urethral strictures, it is not feasible if the urethroscope cannot pass through the stricture point. Herein, we present a pediatric case of severe post-traumatic bulbous urethral stricture that was successfully treated by EVIU after securing the urethral route via interventional balloon dilatation.
CASE SUMMARY A 12-year-old boy presented at our outpatient clinic with the inability to urinate. He had sustained a straddle injury three months prior. The post-void residual urine volume was 644 mL, and retrograde urethrography confirmed severe stricture of the bulbous urethra. EVIU was planned; however, the first attempt to treat the stricture failed because the urethroscope could not pass through the stricture point. The urethral route was subsequently secured via balloon dilatation of the stricture, which was performed in collaboration with specialists from the department of interventional radiology. The urethroscope was then able to pass, and the repeat EVIU was successful.
CONCLUSION Interventional urethral balloon dilatation before EVIU may help secure the urethral route in the treatment of pediatric urethral strictures.
Collapse
Affiliation(s)
- Ji Yong Ha
- Department of Urology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
| | - Mu Sook Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
| |
Collapse
|
|
13
|
Prospects and Challenges of Electrospun Cell and Drug Delivery Vehicles to Correct Urethral Stricture. Int J Mol Sci 2022; 23:ijms231810519. [PMID: 36142432 PMCID: PMC9502833 DOI: 10.3390/ijms231810519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Current therapeutic modalities to treat urethral strictures are associated with several challenges and shortcomings. Therefore, significant strides have been made to develop strategies with minimal side effects and the highest therapeutic potential. In this framework, electrospun scaffolds incorporated with various cells or bioactive agents have provided promising vistas to repair urethral defects. Due to the biomimetic nature of these constructs, they can efficiently mimic the native cells’ niches and provide essential microenvironmental cues for the safe transplantation of multiple cell types. Furthermore, these scaffolds are versatile platforms for delivering various drug molecules, growth factors, and nucleic acids. This review discusses the recent progress, applications, and challenges of electrospun scaffolds to deliver cells or bioactive agents during the urethral defect repair process. First, the current status of electrospinning in urethral tissue engineering is presented. Then, the principles of electrospinning in drug and cell delivery applications are reviewed. Finally, the recent preclinical studies are summarized and the current challenges are discussed.
Collapse
|
|
14
|
Rehan M, Elnady EA, Khater S, Elsayed AFA, Abdel Gawad AM, Freeg MAHA, Mahmoud AR. Comparative study between thulium laser and cold knife visual urethrotomy for treatment of short bulbomembranous urethral stricture. Medicine (Baltimore) 2022; 101:e30235. [PMID: 36107538 PMCID: PMC9439830 DOI: 10.1097/md.0000000000030235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The classical way to treat urethral stricture is the direct vision cold knife internal urethrotomy (DVIU). Along with advances in laser technology, laser urethrotomy is widely used, such as neodymium-doped yttrium aluminum garnet, argon, potassium titanyl phosphate, and thulium laser. We aimed to compare thulium laser urethrotomy (TLU) and cold knife visual urethrotomy (CKVU) in terms of short bulbomembranous urethral stricture management. MATERIALS AND METHODS This prospective interventional study was conducted for 24 months, from January 2018 to January 2020, on 60 patients with primary short bulbo-membranous urethral stricture who came to the Department of Urology of Al-Azhar University Hospital, New Damietta, Egypt. We divided these patients into 2 age-matched groups; 30 patients treated with CKVU and 30 patients with TLU. RESULTS Regarding efficacy, postvoid residual urine volume (PVR) was reduced significantly in both groups (P < .001) after 6 months of follow-up; however, the reduction in TLU was greater than CKVU (P = .008). The improvement of Qmax after 6 months was significant and comparable in both groups. Regarding the quality of life, both groups showed a significant (<0.05) improvement in international prostate symptom score (IPSS) and the Male Sexual Health Questionnaire (MSHQ) scale, without no significant difference between both groups (>0.05). TLU showed a significantly (P = .038) shorter operative duration (24 ± 4.17 min) than CKVU duration (33 ± 4.86 min). Compared with CKVU, TLU was associated with less blood loss during surgery (P = .001), lower recurrence rate (46.7% vs. 19.97%, respectively), and lower frequencies of urethral dilatation (P = .001). CONCLUSION TLU is an effective and safe therapy for managing bulbomembranous urethral strictures, with a relatively low recurrence rate. Further investigations of other techniques are recommended to look for the most appropriate procedure to combat the urethral stricture problem.
Collapse
Affiliation(s)
- Mohamed Rehan
- Urology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
- *Correspondence: Mohamed Rehan, Urology Department, Faculty of Medicine, Al- Azhar University, New Damietta, Egypt 34511, Egypt (e-mail: )
| | - Esam A. Elnady
- Urology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Saed Khater
- Urology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | | | | | - Alaa R. Mahmoud
- Urology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| |
Collapse
|
|
15
|
Revels JW, Wang SS, Weaver JS, Foreman JR, Gallegos MA, Thompson WM, Katz D, Moshiri M. A multimodality review of male urethral imaging: pearls and pitfalls with an update on urethral stricture treatment. Br J Radiol 2022; 95:20211034. [PMID: 35001669 PMCID: PMC10996428 DOI: 10.1259/bjr.20211034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/18/2021] [Accepted: 12/09/2021] [Indexed: 11/05/2022] Open
Abstract
Optimum radiological assessment of the male urethra requires knowledge of the normal urethral anatomy and ideal imaging techniques based on the specific clinical scenario. Retrograde urethrography is the workhorse examination for male urethral imaging, usually utilized as the initial, and often solitary, modality of choice not only in the setting of trauma, but also in the pre- and post-operative evaluation of urethral strictures. There is, however, growing interest in utilization of ultrasound and magnetic resonance for evaluation of the male urethra owing to lack of ionizing radiation and improved delineation of the adjacent tissue. We review the various modalities utilized for imaging of the male urethra for a variety of known or suspected disorders, and provide an update on current treatments of urethral strictures. Additionally, we detail the key information needed by urologists to guide management of urethral strictures. We conclude with a brief discussion of neophallus urethral diseases following female-to-male sexual confirmation surgery.
Collapse
Affiliation(s)
- Jonathan Wesley Revels
- Department of Radiology, University of New
Mexico, Albuquerque, New Mexico,
United States
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of
Utah, Salt Lake City, Utah,
United States
| | - Jennifer S Weaver
- Department of Radiology, University of New
Mexico, Albuquerque, New Mexico,
United States
| | - Jordan R Foreman
- Department of Urology, University of New Mexico,
Albuquerque, New Mexico, United
States
| | - Maxx A Gallegos
- Department of Urology, University of New Mexico,
Albuquerque, New Mexico, United
States
| | - William M Thompson
- Department of Radiology, University of New
Mexico, Albuquerque, New Mexico,
United States
| | - Douglas Katz
- Department of Radiology, NYU Langone Hospital - Long
Island, Mineola, New York,
United States
| | - Mariam Moshiri
- Department of Radiology, Vanderbilt University,
Nashville, Tennessee, United
States
| |
Collapse
|
|
16
|
Heinsimer K, Wiegand L. Erectile and Ejaculatory Dysfunction After Urethroplasty. Curr Urol Rep 2021; 22:19. [PMID: 33554283 DOI: 10.1007/s11934-021-01039-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF THE REVIEW The goal of this paper was to evaluate the impact on erectile and ejaculatory function after anterior and posterior urethroplasty. RECENT FINDINGS With a rise in the use of urethroplasty, its impact on sexual function has come into question. For anterior urethroplasties, some degree of erectile dysfunction is common, but this tends to be transient, with most patients having a resolution of any de novo dysfunction by 12 months. Patients with posterior urethral strictures have a very high rate of erectile dysfunction prior to surgery and may show improvement after urethroplasty. Ejaculatory function tends to improve in patients due to alleviation of obstruction while some patients notice degradation in force of ejaculation. While urethroplasty has a minimal permanent effect on sexual function for most patients, there are some patients who notice improvement and others worsening. Patients should be counseled on these risks prior to urethroplasty.
Collapse
Affiliation(s)
- Kevin Heinsimer
- Department of Urology, University of South Florida, Tampa General Circle, STC Floor 6, Tampa, FL, 33606, USA.
| | - Lucas Wiegand
- Department of Urology, University of South Florida, Tampa General Circle, STC Floor 6, Tampa, FL, 33606, USA
| |
Collapse
|
|
17
|
Kulkarni SB, Pathak H, Khanna S, Choubey S. A prospective, multi-center, open-label, single-arm phase 2b study of autologous adult live cultured buccal epithelial cells (AALBEC) in the treatment of bulbar urethral stricture. World J Urol 2020; 39:2081-2087. [PMID: 32929625 DOI: 10.1007/s00345-020-03415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of autologous adult live cultured buccal epithelial cells (AALBEC) in treatment and management of bulbar urethral stricture in men. METHODS This was a prospective, multi-center, open-label, single-arm phase 2b study. A total of 18 male patients with bulbar urethral stricture of at least 1 - 4 cm in length were enrolled in the study. All 16 patients had AALBEC implanted and were included in the safety set. Change in total American Urology Association (AUA) symptom score, urinary flow rates assessed by uroflowmetry and a requirement for surgery after 24 weeks from baseline were determined in patients. Data of treatment efficacy were analyzed. RESULTS The AUA score at baseline was 21 (3.9) that showed a statistically significant reduction starting from week 2 [8 (4.4), p = 0.0001] which sustained until week 24 [2 (1.2), p = 0.0005]. Overall mean total AUA symptom score was reduced by 90.5% after the treatment. Significant reductions from baseline at week-24 were also observed in voiding time (92.5 (47.3) vs. 51.9 (17.4) s, p = 0.0046) and flow time [86.9 (48.2) vs. 47.9 (19.6) s, p = 0.0052]. All patients showed absence of any significant adverse events. CONCLUSION Significant improvement was seen in the AUA symptom score and uroflowmetry parameters and no patients required surgery during 24 weeks post-treatment. It can be concluded that AALBEC is a safe and effective treatment for bulbar urethral stricture of 1 - 4 cm length to improve the quality of life and the physiological function of urethra.
Collapse
Affiliation(s)
- Sanjay B Kulkarni
- Kulkarni Endo Surgery Institute and Reconstructive Urology Centre, Pune, India.
| | - Hemant Pathak
- TNMC Medical College and B. Y. L. Nair Charitable Hospital, Leelavati Hospital, Mumbai, India
| | | | | |
Collapse
|
|
18
|
Abstract
This section aims to review general principles of endoscopic management of urethral stricture disease and posterior urethral stenosis, with a special focus on the indications for treatment and technical aspects of urethral dilation and internal incision.
Collapse
Affiliation(s)
- James Furr
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, California, USA
| |
Collapse
|
|
19
|
Lee AW, Ramstein J, Cohen AJ, Agochukwu-Mmonu N, Patino G, Breyer BN. The Top 100 Cited Articles in Urethral Reconstruction. Urology 2020; 135:139-145. [DOI: 10.1016/j.urology.2019.08.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 12/11/2022]
|
|
20
|
Sánchez-Pech JC, Rosales-Ibáñes R, Cauich-Rodriguez JV, Carrillo-Escalante HJ, Rodríguez-Navarrete A, Avila-Ortega A, Hernández-Sánchez F. Design, synthesis, characterization, and cytotoxicity of PCL/PLGA scaffolds through plasma treatment in the presence of pyrrole for possible use in urethral tissue engineering. J Biomater Appl 2019; 34:840-850. [PMID: 31630603 DOI: 10.1177/0885328219882638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Raúl Rosales-Ibáñes
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico
| | | | | | | | | | | |
Collapse
|
|
21
|
Culenova M, Ziaran S, Danisovic L. Cells Involved in Urethral Tissue Engineering: Systematic Review. Cell Transplant 2019; 28:1106-1115. [PMID: 31237144 PMCID: PMC6767881 DOI: 10.1177/0963689719854363] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/28/2019] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
The urethra is part of the lower urinary tract and its main role is urine voiding. Its complex histological structure makes urethral tissue prone to various injuries with complicated healing processes that often lead to scar formation. Urethral stricture disease can affect both men and women. The occurrence of this pathology is more common in men and thus are previous research has been mainly oriented on male urethra reconstruction. However, commonly used surgical techniques show unsatisfactory results because of complications. The new and progressively developing field of tissue engineering offers promising solutions, which could be applied in the urethral regeneration of both men´s and women´s urethras. The presented systematic review article offers an overview of the cells that have been used in urethral tissue engineering so far. Urine-derived stem cells show a great perspective in respect to urethral tissue engineering. They can be easily harvested and are a promising autologous cell source for the needs of tissue engineering techniques. The presented review also shows the importance of mechanical stimuli application on maturating tissue. Sufficient vascularization and elimination of stricture formation present the biggest challenges not only in customary surgical management but also in tissue-engineering approaches.
Collapse
Affiliation(s)
- Martina Culenova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of
Medicine, Comenius University, Slovakia
| | | | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of
Medicine, Comenius University, Slovakia
- Regenmed Ltd., Slovakia
| |
Collapse
|
|
22
|
Yudintceva NM, Nashchekina YA, Mikhailova NA, Vinogradova TI, Yablonsky PK, Gorelova AA, Muraviov AN, Gorelov AV, Samusenko IA, Nikolaev BP, Yakovleva LY, Shevtsov MA. Urethroplasty with a bilayered poly-D,L-lactide-co-ε-caprolactone scaffold seeded with allogenic mesenchymal stem cells. J Biomed Mater Res B Appl Biomater 2019; 108:1010-1021. [PMID: 31369698 DOI: 10.1002/jbm.b.34453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/28/2019] [Accepted: 07/17/2019] [Indexed: 01/11/2023]
Abstract
Reconstructive surgery for urethral defects employing tissue-engineered scaffolds represents an alternative treatment for urethroplasty. The aim of this study was to compare the therapeutic efficacy of the bilayer poly-D,L-lactide/poly-ε-caprolactone (PL-PC) scaffold seeded with allogenic mesenchymal stem cells (MSCs) for urethra reconstruction in a rabbit model with conventional urethroplasty employing an autologous buccal mucosa graft (BG). The inner layer of the scaffold based on poly-D,L-lactic acid (PL) was seeded with MSCs, while the outer layer, prepared from poly-ε-caprolactone, protected the surrounding tissues from urine. To track the MSCs in vivo, the latter were labeled with superparamagnetic iron oxide nanoparticles. In rabbits, a dorsal penile defect was reconstructed employing a BG or a PL-PC graft seeded with nanoparticle-labeled MSCs. In the 12-week follow-up period, no complications were detected. Subsequent histological analysis demonstrated biointegration of the PL-PC graft with surrounding urethral tissues. Less fibrosis and inflammatory cell infiltration were observed in the experimental group as compared with the BG group. Nanoparticle-labeled MSCs were detected in the urothelium and muscular layer, co-localizing with the urothelium cytokeratin marker AE1/AE3, indicating the possibility of MSC differentiation into neo-urothelium. Our results suggest that a bilayer MSCs-seeded scaffold could be efficiently employed for urethroplasty.
Collapse
Affiliation(s)
- Natalia M Yudintceva
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Yulia A Nashchekina
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Nataliya A Mikhailova
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Tatiana I Vinogradova
- Saint-Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia
| | - Petr K Yablonsky
- Saint-Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.,Federal State Budgetary Institute, St. Petersburg, Russia
| | - Anna A Gorelova
- Saint-Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.,St. Luca's City Hospital, St. Petersburg, Russia
| | - Alexandr N Muraviov
- Saint-Petersburg State Research Institute of Phthisiopulmonology of the Ministry of Healthcare of the Russian Federation, St. Petersburg, Russia.,Private University, Saint-Petersburg Medico-Social Institute, St. Petersburg, Russia
| | - Andrey V Gorelov
- Federal State Budgetary Institute, St. Petersburg, Russia.,Pokrovskaya Municipal Hospital, St. Petersburg, Russia
| | - Igor A Samusenko
- Federal State Budgetary Institute, The Nikiforov Russian Center of Emergency and Radiation Medicine, Ministry of Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters, St. Petersburg, Russia
| | - Boris P Nikolaev
- Research Institute of Highly Pure Biopreparations, St. Petersburg, Russia
| | | | - Maxim A Shevtsov
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia.,Almazov National Medical Research Centre, Russian Polenov Neurosurgical Institute, St. Petersburg, Russia.,Center for Translational Cancer Research Technische Universität München (TranslaTUM), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
|
23
|
Howard KN, Zhao LC, Weinberg AC, Granieri M, Bernstein MA, Grucela AL. Robotic transanal minimally invasive rectal mucosa harvest. Surg Endosc 2019; 33:3478-3483. [DOI: 10.1007/s00464-019-06893-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 06/04/2019] [Indexed: 01/23/2023]
|
|
24
|
Zheng X, Han X, Cao D, Xu H, Yang L, Ai J, Wei Q. Comparison between cold knife and laser urethrotomy for urethral stricture: a systematic review and meta-analysis of comparative trials. World J Urol 2019; 37:2785-2793. [PMID: 30895360 DOI: 10.1007/s00345-019-02729-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Previous study compared limited number of parameters post the treatment of cold knife and laser urethrotomy for urethral stricture and controversy about the superiority of those two techniques still remains. This study aims to update the evidence and provide better clinical guidance. METHOD We systematically searched Pubmed, Embase, ClinicalTrial.gov, and Cochrane Library Central Register of Controlled Trials for articles comparing cold knife and laser urethrotomy for urethral stricture. Parameters including maximum urinary flow (Qmax), recurrence, reoperation, complications, operation time, and Visual Analog Scale (VAS) pain score were compared using RevMan 5.3. RESULTS Seven articles involving 453 patients were eventually included. The cold-knife group had better 6-month Qmax (MD - 0.95, 95% CI - 1.49 to - 0.41) and similar 3-month and 12-month Qmax compared with the laser group. No significance was observed regarding the comparison of recurrence rate. The laser group had lower risk of bleeding (OR 0.08, 95% CI 0.01-0.43), lower rate of reoperation (OR 0.39, 95% CI 0.19-0.81) and longer operation time (MD 4.09, 95% CI 3.35-4.82). There was no significant difference in terms of other complications and VAS pain score. CONCLUSION Cold knife and laser urethrotomy had similar efficacy regarding short-term and long-term recurrence rate and Qmax, except that the cold-knife group had slightly better 6-month Qmax. However, the laser group had less risk of bleeding and lower rate of reoperation but also longer operation time.
Collapse
Affiliation(s)
- Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Han
- West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hang Xu
- West China Medical School, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
| |
Collapse
|
|
25
|
Akyüz M, Tokuç E, Özsoy E, Koca O, Kanberoğlu H, Öztürk M, Topaktaş R. Characteristics of the urethroplasty and our approach-Experience in patients with urethral stricture. Turk J Urol 2018; 45:307-311. [PMID: 30468425 DOI: 10.5152/tud.2018.68700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Urethral stricture is a common pathology with different etiologic factors in different age groups and societies. In our research, patients who underwent urethroplasty because of urethral stricture were evaluated in terms of etiology, localization, surgical technique and demographic characteristics. MATERIAL AND METHODS One hundred and sixty-three patients with a mean age of 53.43±16.5 years, operated between January 2008 and May 2016 because of urethral stricture were retrospectively included in the study. Diagnosis of the urethral stricture was established based on the complaints of the patient, results of urinalysis, urine culture, uroflowmetry, retrograde urethrography and/or voiding urethrography, and urethroscopy in case of need. Postoperative success for the patients was determined based on urinary flow rate and maximum flow rate of over 15 mL/sec were evaluated as success. RESULTS Etiologic factors for urethral stricture included trauma in 40 (24.5%), urethral catheterization in 45 (27.6%), endoscopic procedure in 59 (36.2%), infection in 10 (6.2%), idiopathic etiologies in 9 (5.5%) out of 163 patients. Mean length of the stricture was 3.6±1.7 cm. While the indicated number of patients had buccal mucosa graft (n=73, 44.7%), penile skin flap (n=21, 12.8%), Heineke-Mikulicz repair (n=5, 3.0%), and end-to-end anastomosis (n=64, 39.1%). Mean follow-up period was 43.2±33.7 months. Buccal mucosa graft was applied as ventral (n=32, 43.8%), dorsal (n=22, 30.2%), and dorsolateral (n=14, 19.2%) onlay, and transventrally dorsal inlay (n=5, 6.8%) grafts. Average success rates were 83.5% (n=61/73) in buccal mucosa, 76.2% (n=16/21) in penile skin grafts; 85.9% (n=55/64) in end-to-end anastomosis and 80.0% (n=4/5) in Heineke-Mikulicz repair. CONCLUSION Our assumption is that urethroplasty procedures have satisfactory long-term results, regardless of the location and size of the stenosis. According to our clinical experience, deciding on the most appropriate surgical technique by assessing each patient individually in experienced centers will increase success rates.
Collapse
Affiliation(s)
- Mehmet Akyüz
- Department of Urology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Emre Tokuç
- Department of Urology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Emrah Özsoy
- Department of Urology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Orhan Koca
- Department of Urology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Hüseyin Kanberoğlu
- Department of Urology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Metin Öztürk
- Department of Urology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Ramazan Topaktaş
- Department of Urology, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
|
26
|
Huang S, Yang C, Li M, Wang B, Chen H, Fu D, Chong T. Effect of dual mTOR inhibitor on TGFβ1-induced fibrosis in primary human urethral scar fibroblasts. Biomed Pharmacother 2018; 106:1182-1187. [DOI: 10.1016/j.biopha.2018.07.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022] Open
|
|
27
|
Li XD, Wu YP, Chen SH, Liang YC, Lin TT, Lin T, Wei Y, Xue XY, Zheng QS, Xu N. Fasudil inhibits actin polymerization and collagen synthesis and induces apoptosis in human urethral scar fibroblasts via the Rho/ROCK pathway. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2707-2713. [PMID: 30214158 PMCID: PMC6126504 DOI: 10.2147/dddt.s156095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose To examine the effects and mechanism of action of fasudil on cytoskeletal polymerization, collagen synthesis, and apoptosis in fibroblasts derived from human urethral scar tissue. Materials and methods Fibroblasts treated with or without transforming growth factor β1 (TGF-β1, 10 ng/mL) were incubated with fasudil (12.5, 25, 50 μmol/L) for 24 hours. Quantitative real-time polymerase chain reaction and Western blotting were used to determine the expression of Arp2, Arp3, WASP, and WAVE2. Collagen I and III protein levels were also evaluated by Western blotting. The filamentous actin cytoskeleton was examined by immunofluorescence and epifluorescence microscopy. An Annexin V-FITC/PI staining assay was used to investigate apoptosis. Results TGF-β1-dependent induction of actin polymerization and collagen synthesis and promotion of apoptosis were dose dependent. When compared with untreated controls, fasudil significantly decreased the expression of Arp2, Arp3, WASP, WAVE2, Collagen I, and Collagen III in cells treated with or without TGF-β1. Fasudil also promoted apoptosis in cells, irrespective of TGF-β1 treatment. Conclusion Irrespective of TGF-β1 activation status, fasudil suppressed actin polymerization and collagen synthesis and induced apoptosis in human urethral scar fibroblasts via the Rho/ROCK signaling pathway.
Collapse
Affiliation(s)
- Xiao-Dong Li
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Yu-Peng Wu
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Shao-Hao Chen
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Ying-Chun Liang
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Ting-Ting Lin
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Tian Lin
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Yong Wei
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Xue-Yi Xue
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Qing-Shui Zheng
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| | - Ning Xu
- Departments of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China,
| |
Collapse
|
|
28
|
Benson CR, Hoang L, Clavell-Hernández J, Wang R. Sexual Dysfunction in Urethral Reconstruction: A Review of the Literature. Sex Med Rev 2018; 6:492-503. [DOI: 10.1016/j.sxmr.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 01/04/2023]
|
|
29
|
Soave A, Dahlem R, Pinnschmidt HO, Rink M, Langetepe J, Engel O, Kluth LA, Loechelt B, Reiss P, Ahyai SA, Fisch M. Substitution Urethroplasty with Closure Versus Nonclosure of the Buccal Mucosa Graft Harvest Site: A Randomized Controlled Trial with a Detailed Analysis of Oral Pain and Morbidity. Eur Urol 2018; 73:910-922. [DOI: 10.1016/j.eururo.2017.11.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/17/2017] [Indexed: 11/27/2022]
|
|
30
|
Barbalias D, Lappas G, Ravazoula P, Liourdi D, Kyriazis I, Liatsikos E, Kallidonis P. Evaluation of the Distribution of Paclitaxel After Application of a Paclitaxel-Coated Balloon in the Rabbit Urethra. J Endourol 2018; 32:381-386. [PMID: 29382215 DOI: 10.1089/end.2017.0935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Urethral strictures are a common urologic problem that could require complex reconstructive procedures. Urethral dilatation represents a frequent practiced intervention associated with high recurrence rates. Drug-coated percutaneous angioplasty balloons (DCBs) with cytostatic drugs have been effectively used for the prevention of vascular restenosis after balloon dilatation. To reduce restenosis rates of urethral dilatation, these balloons could be used in the urethra. Nevertheless, the urothelium is different than the endothelium and these drugs may not be distributed to the outer layers of the urethra. Thus, an experiment was performed to evaluate the distribution of paclitaxel (PTX) in the rabbit urethra after the inflation of a PTX-coated balloon (PCB). MATERIALS AND METHODS Eleven rabbits underwent dilatation of the posterior urethra with common endoscopic balloons after urethrography. Nine of these rabbits were additionally treated with PCB. The urethras of the two control animals were removed along with three more dilated with PCB urethras immediately after the dilatation. The remaining of the urethras were removed after 24 (n = 3) and 48 hours (n = 3). The posterior segments of the urethras were evaluated with hematoxylin and eosin staining as well as with immunohistochemistry with polyclonal anti-PTX antibody. RESULTS The two control specimens showed denudation of the urothelium after balloon dilatations and no PTX was observed. All specimens from dilated PCB urethras showed distribution of PTX to all layers of the urethra. The specimens that were immediately removed exhibited denudation of the urothelium without any inflammation. The specimens removed at 24 and 48 hours showed mild acute inflammation. CONCLUSION PTX was distributed to the urothelial, submucosal, and smooth muscle layers of the normal rabbit urethra immediately after dilatation with a DCB. PTX and mild inflammation were present at the site 24 and 48 hours after the dilatation.
Collapse
Affiliation(s)
| | - Georgios Lappas
- 1 Department of Urology, University of Patras , Patras, Greece
| | | | - Despoina Liourdi
- 3 Department of Internal Medicine, General Hospital of Patras , Patras, Greece
| | - Iason Kyriazis
- 1 Department of Urology, University of Patras , Patras, Greece
| | - Evangelos Liatsikos
- 1 Department of Urology, University of Patras , Patras, Greece
- 4 Department of Urology, Medical University of Vienna , Vienna, Austria
| | | |
Collapse
|
|
31
|
Rapamycin Inhibits the Growth and Collagen Production of Fibroblasts Derived from Human Urethral Scar Tissue. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7851327. [PMID: 29850566 PMCID: PMC5932518 DOI: 10.1155/2018/7851327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/15/2018] [Accepted: 03/01/2018] [Indexed: 11/17/2022]
Abstract
Rapamycin can inhibit fibroblast proliferation, collagen accumulation, and urethral stricture in rabbits. Transforming growth factor-beta-1 (TGF-β1) signaling, with downstream recruitment of Smad2, is known to promote fibrosis. This in vitro study examined the effects of rapamycin on fibroblasts derived from human urethral scar tissue (FHUS) and investigated the possible mechanism with respect to regulation of TGF-β1 signaling. FHUS were cultured from urethral scar tissues collected from four patients with urethral stricture. The cells were exposed to different concentrations of rapamycin (0, 10, 20, 40, 80, or 160 ng/ml) for 24 or 48 hours. Cell growth was assessed by the MTT assay. Collagen content was measured based on hydroxyproline levels. The mRNA expressions of Smad2, eIF-4E, and alpha-1 chains of collagen types I and III (Col1α1 and Col3α1) were determined by semiquantitative reverse-transcription PCR. The protein expressions of Smad2, phospho-Smad2, and eIF-4E were evaluated by western blot. Rapamycin caused a concentration-dependent inhibition of FHUS growth at 24 and 48 hours (P < 0.01). Rapamycin decreased total collagen content (P < 0.01), collagen content per 105 cells (P < 0.05), and mRNA expressions of Col1α1 and Col3α1 (P < 0.05) in a concentration-dependent manner. Rapamycin elicited concentration-dependent reductions in the mRNA (P < 0.05) and protein (P < 0.01) expressions of Smad2 and eIF-4E. The two highest concentrations of rapamycin also enhanced phospho-Smad2 levels (P < 0.01). In conclusion, the present study confirmed that rapamycin may reduce the growth and collagen production of FHUS, possibly through inhibition of TGF-β1 signaling.
Collapse
|
|
32
|
Evans P, Keihani S, Breyer BN, Erickson BA, Hotaling JM, Lenherr SM, Myers JB. A Prospective Study of Patient-reported Pain After Bulbar Urethroplasty. Urology 2018; 117:156-162. [PMID: 29656064 DOI: 10.1016/j.urology.2018.02.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand the prevalence of chronic perineal pain, activity limitations, and patient satisfaction after urethroplasty. METHODS From 2014 to 2016, we prospectively enrolled men undergoing urethroplasty for bulbar urethral strictures. Patients, before and after surgery, completed questions from the Core Lower Urinary Tract Symptom Score assessing pain frequency in the bladder and penis or urethra, as well as nonvalidated questions assessing perineal pain. Overall satisfaction with their current urinary condition and pain-related activity limitations at home, work, or during exercise were also measured. Patients with <3 months of follow-up were excluded. Pre-and postoperative scores were compared using the Wilcoxon signed-rank test. RESULTS Thirty-five men were included in the study. Mean age and body mass index were 44.6 years and 30.9 kg/m2, respectively. Urethroplasties were anastomotic in 24 (69%) and were single-stage buccal graft substitution in 11 (31%). Median follow-up after surgery was 483 days (range: 90-810 days). A total of 10 patients (29%) reported worsening perineal pain intensity after surgery, whereas 8 (23%) reported improvement and 17 (48%) reported no change. Overall, pain frequency in the bladder, penis or urethra, and perineum improved. Home and exercise pain-related activity restrictions improved significantly after surgery. Satisfaction with current urinary condition also improved with 91% reporting feeling "delighted," "pleased," or "mostly satisfied" with their current condition. CONCLUSION Patients are highly satisfied with their urinary condition after urethroplasty. Pain frequency in the bladder and the urethra significantly improves after urethroplasty; however, perineal pain intensity can worsen and become chronic after surgery in some patients.
Collapse
Affiliation(s)
- Patrick Evans
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Sorena Keihani
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT.
| | - Benjamin N Breyer
- Department of Urology, University of San Francisco California, San Francisco, CA
| | | | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Sara M Lenherr
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT
| |
Collapse
|
|
33
|
Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease. Curr Urol Rep 2018; 19:19. [PMID: 29479640 DOI: 10.1007/s11934-018-0771-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Male urethral stricture disease is characterized by the formation of scar tissue within the urethra resulting in lower urinary tract symptoms, infection, and potentially kidney dysfunction. There is significant variability in clinical practice for the treatment of urethral stricture. We sought to summarize the known data on endoscopic management of urethral stricture disease as part of this larger edition on urethral stricture management. RECENT FINDINGS Older studies quoted high rates of success with endoscopic management of urethral stricture, including repeated DVIU. There is now evidence to support a limited role of endoscopic intervention in the management of urethral stricture, and especially strong evidence that repeated endoscopic procedures are not effective. There is poor evidence to support the long-term efficacy of endoscopic urethral stricture management. Furthermore, novel advances in adjunctive therapies have not yet demonstrated durable patency. We discuss the limited role of endoscopic management and suggest an algorithm for its use in stricture management.
Collapse
|
|
34
|
Kumano Y, Kawahara T, Mochizuki T, Takamoto D, Takeshima T, Kuroda S, Teranishi J, Makiyama K, Miyoshi Y, Yumura Y, Yao M, Uemura H. Management of urethral stricture: High‐pressure balloon dilation versus optical internal urethrotomy. Low Urin Tract Symptoms 2017; 11:O34-O37. [DOI: 10.1111/luts.12208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/03/2017] [Accepted: 09/25/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Yohei Kumano
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
| | - Takashi Kawahara
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
- Department of UrologyYokohama City University Graduate School of Medicine Yokohama Japan
| | - Taku Mochizuki
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
| | - Daiji Takamoto
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
| | - Teppei Takeshima
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
| | - Sinnnosuke Kuroda
- Department of UrologyYokohama City University Graduate School of Medicine Yokohama Japan
| | - Jun‐ichi Teranishi
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
| | - Kazuhide Makiyama
- Department of UrologyYokohama City University Graduate School of Medicine Yokohama Japan
| | - Yasuhide Miyoshi
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
| | - Yasushi Yumura
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
| | - Masahiro Yao
- Department of UrologyYokohama City University Graduate School of Medicine Yokohama Japan
| | - Hiroji Uemura
- Departments of Urology and Renal TransplantationYokohama City University Medical Center Yokohama Japan
| |
Collapse
|
|
35
|
Ferriero M, Gabriele T, Simone G. Editorial Comment. Urology 2017; 107:237-238. [DOI: 10.1016/j.urology.2017.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|