Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Prolonged Disease Duration
ABSTRACT We examined the association of previous transurethral manipulation with stricture complexity and disease duration among men referred for bulbar urethral reconstruction.
We retrospectively reviewed the records of 340 consecutive urethroplasties performed by a single surgeon between July 2007 and October 2010. Only men treated with initial open surgery for bulbar strictures were included in analysis, thus excluding those with hypospadias, lichen sclerosus, pelvic radiation, prior urethroplasty, incomplete data, or pure penile or posterior urethral stenosis. Cases were divided into 2 groups based on the history of transurethral treatment for urethral stricture before urethroplasty, including group 1-0 or 1 and group 2-2 or greater treatments.
Of 101 patients with bulbar urethral stricture and all data available 50 and 51 underwent 0 to 1 and 2 or greater previous transurethral treatments, respectively. Repeat transurethral manipulation was strongly associated with longer strictures and the need for complex reconstruction. Repeat transurethral manipulation of bulbar urethral strictures was also associated with an eightfold increase in disease duration between stricture diagnosis and curative urethroplasty.
Repeat transurethral manipulation of bulbar strictures is associated with increased stricture complexity and a marked delay to curative urethroplasty.
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- "Also, PER followed by repeated instrumentation seemed to complicate the performance of posterior urethroplasty, an already challenging procedure. As might be expected, repeated dilatations can propagate scar formation , and in our experience, PER actually increased periurethral fibrosis (Fig. 1). Unfortunately, we also noted a wide range of adverse sequelae in these patients, e.g., synchronous stricture formation, false passages, initial urethroplasty failure, and/or infectious complications. "
ABSTRACT: To review previous reports and present our experience on the outcomes after treating pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) vs. placing a suprapubic tube (SPT) with elective bulbomembranous anastomotic urethroplasty (BMAU). We reviewed previous reports and identified articles that reported outcomes after PER vs. SPT and elective BMAU for patients who sustained PFUIs. We also present our institutional experience of treating patients who were referred after undergoing either form of treatment. The success rates for PER after PFUI are wide-ranging (11-86%), with variable definitions for a successful outcome. At our institution, for patients treated by SPT/BMAU, the mean time to a definitive resolution of stenosis was dramatically shorter (6 months, range 3-15) than for those treated with PER (122 months, range 4-574; P < 0.01). The vast majority of patients treated by PER required multiple endoscopic urethral interventions (median 4, range 1-36;P < 0.01) and/or had various other adverse events that were rare among the SPT/BMAU group (14/17, 82%, vs. 2/23, 9%;P < 0.05). While PER occasionally results in urethral patency with no need for further intervention, the risk of delay in definitive treatment and the potential for adverse events have led to a preference for SPT and elective BMAU at our institution.02/2015; 161(1). DOI:10.1016/j.aju.2014.12.005
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ABSTRACT: The most commonly used treatment modality for urethral strictures is the direct visual internal urethrotomy (DVUI) method according to Sachse. It is an effective short-term treatment, but the long-term success rate is low. A number of factors influence the outcome of DVUI including stricture location, spongiofibrosis and previous endoscopic stricture treatment. Multiple urethrotomy has a negative impact on the success rate of subsequent urethroplasty. A thorough preoperative diagnostic work-up including combined retrograde urethrogram/voiding cystourethrogram (RUG/VCUG) and urethrocystoscopy is, therefore, mandatory to allow for patient counselling regarding the risk of stricture recurrence and other treatment options. After a failed primary DVUI, subsequent urethrotomy cannot be expected to be curative.Der Urologe 04/2013; 52(5). DOI:10.1007/s00120-013-3116-6 · 0.44 Impact Factor
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ABSTRACT: Die Urethrotomie nach Sachse ist die am häufigsten durchgeführte Behandlungsmethode bei Harnröhrenstrikturen. Sie stellt eine effektive kurzzeitige Therapieoption für diese Patienten dar, allerdings steigt die Rezidivrate deutlich mit zunehmendem Follow-up. Faktoren wie eine penile Lokalisation der Striktur, Spongiofibrose oder vorhergehende Operationen beeinflussen das Ergebnis der Urethrotomie negativ, und multiple Urethrotomien beeinflussen ihrerseits das Ergebnis einer offenen Harnröhrenrekonstruktion negativ. Eine ausführliche präoperative Diagnostik mit kombiniertem RUG/MCU und Urethrozystoskopie ist folglich essentiell, um Strikturlokalisation, -länge und Spongiofibrose beurteilen und Patienten bezüglich der Rezidivwahrscheinlichkeit und der Therapiealternativen aufklären zu können. Nach einer erfolglosen primären Urethrotomie sind Folgeurethrotomien als nicht kurativ anzusehen.Der Urologe 05/2013; 52(5). · 0.44 Impact Factor