Repeat Transurethral Manipulation of Bulbar Urethral Strictures is Associated With Increased Stricture Complexity and Prolonged Disease Duration

Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
The Journal of urology (Impact Factor: 4.47). 03/2012; 187(5):1691-5. DOI: 10.1016/j.juro.2011.12.074
Source: PubMed


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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    • "Urethral reconstruction is usually offered only after repeated failed transurethral stricture treatments, which in some cases span several years [13]. Unfortunately, repeated transurethral manipulation of bulbar strictures is associated with increased stricture complexity, stricture length, and a marked delay to curative urethroplasty [14]. Few studies have shown longterm follow-up of patients after VIU [11]. "
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    ABSTRACT: Objective . To determine the long-term stricture-free rate after visual internal urethrotomy following initial and follow-up urethrotomies. Methods . The records of all male patients who underwent direct visual internal urethrotomy for urethral stricture disease in our hospital between July 2004 and May 2012 were reviewed. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, third, fourth, and fifth urethrotomies. Results . A total of 301 patients were included. The overall stricture-free rate at the 36-month follow-up was 8.3% with a median time to recurrence of 10 months (95% CI of 9.5 to 10.5, range: 2–36). The stricture-free rate after one urethrotomy was 12.1% with a median time to recurrence of eight months (95% CI of 7.1–8.9). After the second urethrotomy, the stricture-free rate was 7.9% with a median time to recurrence of 10 months (95% CI of 9.3 to 10.6). After the third to fifth procedures, the stricture-free rate was 0%. There was no significant difference in the stricture-free rate between single and multiple procedures. Conclusion . The long-term stricture-free rate of visual internal urethrotomy is modest even after a single procedure.
    Full-text · Article · Oct 2015 · Advances in Urology
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    • "Similarly, DVIU was the most common procedure followed by urethral dilatation, stent/steroid injection in a review of Medicare claims [5]. However, it has been shown that multiple transurethral manipulations increases the complexity and disease duration when patients are referred for definitive urethroplasty [6]. Therefore, identifying patients at risk of recurrence after DVIU is crucial. "
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    ABSTRACT: Objective: To identify patient and stricture characteristics predicting failure after direct vision internal urethrotomy (DVIU) for single and short (<2 cm) bulbar urethral strictures. Patients and methods: We retrospectively analysed the records of adult patients who underwent DVIU between January 2002 and 2013. The patients' demographics and stricture characteristics were analysed. The primary outcome was procedure failure, defined as the need for regular self-dilatation (RSD), redo DVIU or substitution urethroplasty. Predictors of failure were analysed. Results: In all, 430 adult patients with a mean (SD) age of 50 (15) years were included. The main causes of stricture were idiopathic followed by iatrogenic in 51.6% and 26.3% of patients, respectively. Most patients presented with obstructive lower urinary tract symptoms (68.9%) and strictures were proximal bulbar, i.e. just close to the external urethral sphincter, in 35.3%. The median (range) follow-up duration was 29 (3-132) months. In all, 250 (58.1%) patients did not require any further instrumentation, while RSD was maintained in 116 (27%) patients, including 28 (6.5%) who required a redo DVIU or urethroplasty. In 64 (6.5%) patients, a redo DVIU or urethroplasty was performed. On multivariate analysis, older age at presentation [odds ratio (OR) 1.017; P = 0.03], obesity (OR 1.664; P = 0.015), and idiopathic strictures (OR 3.107; P = 0.035) were independent predictors of failure after DVIU. Conclusion: The failure rate after DVIU accounted for 41.8% of our present cohort with older age at presentation, obesity, and idiopathic strictures independent predictors of failure after DVIU. This information is important in counselling patients before surgery.
    Full-text · Article · Sep 2015 · Arab Journal of Urology
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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 [10], 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. "
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    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.
    Full-text · Article · Feb 2015 · Arab Journal of Urology
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