Treatment of Urethral Strictures in Transmasculine Patients (original) (raw)

A retrospective analysis of urethral strictures and their management at a tertiary care center

ijnu.ir

Background: Surgical treatment of urethral strictures includes numerous options such as dilation, internal urethrotomy, stenting and reconstructive surgical techniques. Short uncomplicated strictures are generally amenable to complete excision with primary anastomosis. We performed a retrospective evaluation and analysis of outcome in patients who underwent any kind of treatment for urethral strictures. Objectives: To evaluate and analyze the outcome in patients who underwent treatment for urethral stricture disease over the last 15 years (May 1993 to June 2008), at a tertiary care centre, as well as to determine the treatment option to be utilized in different varieties of urethral strictures. Patients and Methods: We reviewed 524 patients who underwent treatment for urethral strictures between May 1993 and June 2008. Mean follow-up was 68 months. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine estimation, uroflowmetry, and retrograde and voiding cystourethrography. Since 2000 urethral ultrasound was also performed in all patients. Clinical outcome was assessed by comparing pre and post operative investigation and patient satisfaction. Results: Stricture etiology was catheter induced (15.36%), blunt perineal trauma (59.2%), instrumentation (12%), spontaneous (3.52%) and infection (10%). Stricture length was 0 to1cm (in 9.92%) 1 to 2 cm (in 32%), 2 to 3 cm (17.28%), 3 to 4 cm (24%) or 4 to 5 cm (8.8%) more than 5cm (16%). The success rates in these procedures were 93.6% (TAU-Tunica albuginea urethroplasty), 94.4% (USPBA-U shaped Prostato-bulbar Anastomosis), 91.7% (BMSU-Buccal Mucosa urethroplasty), 90% (IOU-Internal optic urethrotomy), 90.35% (dilatation) and 81% (two staged urethroplasty). There were 129 patients (25.49%) who experienced ejaculatory dysfunction. Good and fair results were considered successful. Of 524 cases 480 (91.6%) were successful and 44 (8.4%) were treatment failures. Conclusions: We conclude that the treatment of urethral strictures should be individualized, taking into account the location, length and extent of spongiofibrosis.

Male urethral strictures and their management

Nature Reviews Urology, 2013

| Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8-80%, with long-term success rates of 20-30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85-90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.

Trends in urethral stricture management over two decades

BJU International

To identify trends in the management of urethral stricture disease in Australia, assess changes in the standard of care, and examine the availability of genitourinary reconstructive surgery. Methods Data on eight stricture management procedures were collected online via Medicare Item Reports from the Australian Government Department of Human Services, and then matched to population data from the Australian Bureau of Statistics. A survey was disseminated via the Urological Society of Australia and New Zealand (USANZ) asking whether active members performed urethroplasty and whether this was done in a rural, regional or metropolitan setting. Results Over a 22-year period, there were 140 540 endoscopic procedures and 5136 urethroplasties, with 27.4 endoscopic procedures per urethroplasty. From 1994 to 2016, the per capita number of passage of sounds and dilatation procedures decreased by 74% and 75%, respectively, with increases in use of optical urethrotomy of 70% and in single-stage urethroplasty of 144%. Overall, the ratio of all endoscopic procedures vs urethroplasty decreased from 58.9 to 16.8. There were as few as 16 surgeons in the USANZ performing urethroplasty, with seven providing this service in regional areas. Seven had formal fellowship training. Conclusion There has been a clear shift from repetitive endoscopic procedures towards urethroplasty, but the former still make up the majority of interventions. This may be explained by patients not being referred for urethroplasty earlier in the course of disease and there appears to be a gap in genitourinary reconstructive expertise in regional and rural areas.

Management of Stricture Urethra: Our Experience at a Tertiary Care Centre

International Journal of Contemporary Medical Research [IJCMR], 2020

Introduction: Upto 300 per 100000 men are affected by urethral stricture disease. Urethral stricture is by definition a narrowing of urethra caused by scarring. Stricture disease could be induced due to a variety of causes and can be detrimental for the health and quality of life of the patient. A wide variety of interventions are performed by the practising urologist for stricture urethra including dilatation, visual internal uretherotomy (VIU) and urethroplasty. The aim of this study was to review the outcomes of various treatment modalities for stricture urethra at our centre. Material and methods: The study was conducted in a prospective observational manner in a tertiary care centre over a period of 18 months. All cases of male urethral stricture undergoing intervention were included in this study. Treatment options included Visual internal uretherotomy (VIU), anastomotic urethroplasty and augmented urethroplasty. Patient factors, stricture factors and surgical outcomes, recurrence rates were analysed. Results: Eighty seven cases of male stricture urethra were included in the study. Idiopathic strictures(40%) were the commonest aetiology followed by traumatic(36.7%), iatrogenic(14.9%) and inflammatory strictures(8%). Commonest site was the bulbar urethra(35.6%) followed by penile urethra. Augmented urethroplasty was done in 33 patients, while 25 patients underwent anastomotic urethroplasty. VIU was done in 29 patients. Success rate of interventions in our study was 89.7% at 12 months of follow-up (VIU-80%, augmented urethroplasty-96.6% and anastomotic urethroplasty-92.2%). Conclusion: A reconstructive urologist must be familiar with a variety of techniques to tackle strictures of the urethra. VIU was used predominantly for single short segment bulbar strictures but showed high recurrence rates(20%). Urethroplasty had better outcomes in terms of recurrence rate(5%), proving why it is considered the gold standard for treating urethral strictures.

Management of Catheter-Associated Urethral Strictures

Orient Journal of Medicine, 2020

Background: Urethral stricture is an abnormal narrowing or loss of distensibility of any segment of the urethra surrounded by corpus spongiosum. In the last two decades, there has been a change in the pattern of aetiology of urethral stricture in urban centres in Nigeria with a shift away from post-infective strictures to the emergence of traumatic and iatrogenic causes.Objective: This study aims to present our observation of the occurrence of long-segment urethral strictures in patients after urethral catheter placement for various indications.Methodology: This is a descriptive, cross sectional report of patients who presented to and were managed at the Urology Unit of a tertiary hospital in North-Western Nigeria. Relevant information were retrieved from patients’ case notes and the data was entered into a proforma and analysed using the SPSS 20 software.Results: The mean age of the patients was 45.4 ± 19.4 years, with a range of 11-80 years. Indications for urethral catheterizatio...

Characteristics of the urethroplasty and our approach-Experience in patients with urethral stricture

Türk Üroloji Dergisi/Turkish Journal of Urology, 2018

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.

Case Report On Urethral stricture

The Journal of RURAL NURSING

This clinical guideline’s goal is to establish a foundation for detecting and treating male urethral stricture. Resources and procedures: Pubmed, Embase, and Cochrane are three databases that can be used to find information.were searched for peerreviewed literature related urethral stricture: a guide to diagnosis and treatment (search dates 1/1/1990 to 12/1/15). The review produced a data collection of 250 papers after applying inclusion/exclusion criteria. The Guideline statements were based on these publications. Patients’ benefits and risks/burdens were used to produce Strong, Moderate, or Conditional Recommendations When there was inadequate evidence, additional guidance was given Clinical Principles and Expert Opinion are two types of evidence that can be found in the literature. Systems and Important clinical Finding : urination difficulties, straining, or pain, inadequate bladder emptying, pee stream sprayed, need to urinate more frequently or have a stronger urge to urinate....

Approaches in the treatment of urethral strictures

Eastern Journal Of Medicine, 2019

Urethral strictures are defined as the narrowing of the anterior urethral lumen or as corpus spongiosum fibrosis. Anterior urethral strictures can be divided as iatrogenic, inflammatory, idiopathic, and traumatic based on their etiology. Lower urinary tract septomas develop as a result of this disease. Many complications may occur in untreated patients.Cystoscopy, retrograde urethrography and ultrasonography can be used to diagnose the disease.Treatment methods are endoscopic and open surgery.Endoscopic treatment methods include dilatation, cold knife and laser internal uretrotomy. Recurrent bulbar urethral strictures; "End-to-end anastomosis urethroplasty" technique for short stenosis shorter than 2 cm. The technique of like ogmented anastomosis urethroplasty an with buccal graft is used for longer or complicated stenosis.

Management of Urethral Stricture in Women

The Journal of Urology, 2012

We describe the diagnosis and treatment of urethral strictures in women. Materials and Methods: We retrospectively identified female urethral strictures from 1998 to 2010. Study inclusion criteria were 1) clinical diagnosis of stricture, 2) stricture seen on cystoscopy, 3) urethral obstruction on videourodynamics according to the Blaivas-Groutz nomogram and/or 4) urethral caliber less than 17Fr. Postoperative recurrence was defined by the preoperative criteria. Results: We identified 17 women with a mean age of 62 years (range 32 to 91) with stricture. Stricture was idiopathic in 8 patients, iatrogenic in 6, traumatic in 2 and associated with a urethral diverticulum in 1. Videourodynamics could not be done in 3 women due to complete obliteration of the urethra. Ten of 14 patients satisfied videourodynamic criteria for obstruction and 4 had impaired detrusor contractility. Nine women underwent vaginal flap urethroplasty, including 5 who also had a pubovaginal sling and 1 who had a Martius flap. One patient received a buccal mucosal graft as primary treatment after initial dilation. There was no recurrence at a minimum 1-year followup but 2 strictures recurred 5½ and 6 years postoperatively, respectively. These 2 women received a buccal mucosal graft and were stricture free 12 to 15 months postoperatively. Of 17 patients initially treated with urethral dilation recurrence developed in 16, requiring repeat dilations until urethroplasty was performed. Conclusions: In select women vaginal flap urethroplasty and buccal mucosal graft have high success rates, including 100% at 1 year and 78% at 5 years. Urethral dilation has a 6% success rate. Long-term followup is mandatory. Treatment should be individualized.