Delayed Reconstruction of Bulbar Urethral Strictures is Associated with Multiple Interventions, Longer Strictures and More Complex Repairs

Viers, Boyd R.; Pagliara, Travis; Shakir, Nabeel; Rew, Charles; Folgosa-Cooley, Lauren; Scott, Jeremy; Morey, Allen F.

doi:10.1016/j.juro.2017.08.081

Cited by 26 publications

(11 citation statements)

References 25 publications

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“…Detailed screening procedure is displayed in the Fig. 1.There were 9 studies (total 2279 patients) contained smokingstricture recurrence univariate analysis information [3,[8][9][10][11][12][13][14][15], 7 studies (total 2074 patients) contained multivariable analysis information [6, 7, 11-13, 16, 17]. Out of 12 involved studies, 11 studies are retrospective cohort studies and only 1 study was prospectively designed.…”

Section: Results 21 Study Selectionmentioning

confidence: 99%

“…Some risk factors such as the length of stricture and etiology have attracted the attention of urologists, but other factors such as tobacco consumption has not been evaluated carefully [1,3,8,19] This meta-analysis revealed that tobacco consumption can make the chance of stricture recurrence significantly increased based on both univariate and multivariate analysis. In the multivariate analysis stage, the sensitivity analysis result was not exactly stable, this indicated that more multivariate analysis studies and adjusted estimate between smoking and stricture recurrence were required.…”

Section: Discussionmentioning

confidence: 99%

“…When urologists deal with the urethral stricture patients by urethroplasty, one of the most worrying situations is the stricture recurrence. In order to find out the possible causes of postoperative stricture recurrence, many retrospective studies have been conducted, and many risk factors such as length of stricture [1][2][3], previous urethroplasty history [2,[4][5][6], direct visual internal urethrotomy (DVIU) history have been reported [2,3,7,8]. However, in addition to these risk factors that have a strong role in promoting stricture recurrence, there are still some risk factors that are relatively mild or need a long time for stricture promotion, which can only be described by a large sample size of clinical research.…”

Section: Introductionmentioning

confidence: 99%

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Is There a Relationship Between Smoking and Stricture Recurrence After the Urethroplasty? a Systematic Review and Meta-Analysis

Wang

Jian

et al. 2020

Preprint

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Background Some retrospective studies have noted that smoking is a possible risk factor for recurrence of restenosis after urethroplasty, but not all of them are consistent. Therefore a meta-analysis is needed. Method Pubmed, Web of Science, Embase, Cochrane databases were searched with key words: “urethroplasty”, “buccal mucosa graft urethroplasty”, “oral mucosa graft urethroplasty”, “excision and primary anastomosis urethroplasty”, “urethral stricture recurrence” until Jan 30, 2020. The quality of included studies was assessed by Newcastle-Ottawa Scale (NOS) system. Hazard ratio (HR), odds ratio (OR), relative risk (RR) with 95% confidence interval (CI) were extracted or re-calculated from included studies. Meta-analysis was performed with Stata 15.0 based on univariate and multivariate data separately. Sensitivity analysis was performed to test stability of meta-analysis. I 2 was calculated to evaluate heterogeneity. Publication biases were assessed by egger’s and begg’s tests. Funnel plots of univariate analysis and multivariate analysis were also offered. Results 12 studies with 3443 patients were involved into this meta-analysis. The analysis results of two stages were consistent. In the univariate meta-analysis stage, 9 studies with 2279 patients were pooled and the result indicated that smoking might promote stricture recurrence (RR=1.46, 95%CI: 1.11-1.93, P=0.008). In the multivariate meta-analysis stage, based on adjusted estimate, 7 studies with 2074 patients were pooled and the result indicated that smoking might promote stricture recurrence (RR=1.39, 95%CI: 1.04-1.85, P=0.026). There was no significant heterogeneity in both univariate and multivariate stage. Conclusion This meta-analysis of current evidence indicates that smoking may prompt stricture recurrence after the urethroplasty. Quitting smoking may be a good option for patients undergoing urethroplasty surgery.

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Section: Results 21 Study Selectionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is There a Relationship Between Smoking and Stricture Recurrence After the Urethroplasty? a Systematic Review and Meta-Analysis

Wang

Jian

et al. 2020

Preprint

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“…This can be associated with the high rate of previously operated patients, and the traumatic etiology of the stricture, both of them being risk factors for therapeutic failure. 22,23 Additionally, our definition of therapeutic failure was defined as any urethral dilation after surgery, which increases the number of patients considered as therapeutic failures. Nonetheless, from a subjective point of view, when applying the USS-PROMS tool on our patients, we found that the mean score for obstructive urinary symptoms was low, that the satisfaction grade of the patients was of 93%, and that all of the patients would recommend the procedure to other patients.…”

Section: Discussionmentioning

confidence: 99%

Urethral Reconstruction in a Reference Center in Eastern Colombia

et al. 2019

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Introduction and Objectives Urethral stricture is a complex pathology of multiple etiologies, and of unknown incidence in our country. There are multiple options for the management of urethral stricture, from minimally invasive procedures, like urethral dilation or direct vision internal urethrotomy, to open surgical reconstruction using excision and primary anastomosis (EPA), or augmented urethroplasty with tissue graft.The aim of the present study is to describe the characteristics of the patients managed with urethral reconstructive surgery in a reference center in eastern Colombia. Methods Observational retrospective cohort study. Data was obtained from patients undergoing urethral reconstructive surgery at the institution from August 2013 to December 2017. All of the surgeries were performed by the same surgical team. The clinical and demographic variables were collected, and the validated urethral stricture surgery patient-reported outcome measure (USS-PROM) questionnaire was applied. Results A total of 56 patients were included in the study, 26 patients (46.4%) underwent excision and primary anastomosis (EPA), and 30 (53.6%) underwent graft urethroplasty. The average age at the time of the intervention was 53.3 years old. The most frequent etiology was trauma, and the mean length of the stenosis was 1.7 cm for the EPA group, and 3 cm for the graft urethroplasty group (p = 0.009). A history of previous surgery was found in 66% of the patients, and radiotherapy in 2 patients.The mean follow-up was of 14 months (range: 0–52 months), observing similar success rates for both techniques. Despite of the small sample size, when analyzing the Kaplan-Meier curves, we observed a tendency of a better response in the group without previous treatments and with stenosis with a length < 2 cm.The rate of postoperative complications was of 23%, with no statistical difference between the 2 groups. The USS-PROM questionnaire was applied to 29 patients, finding that 27 out of 29 respondents were satisfied with the results of the procedure, and all of them would recommend it to another person. Conclusions The results of our study show that urethral reconstruction surgery performed in an experienced center is associated with a good success rate, and that patients are satisfied with the result of the procedure.

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“…In erfahrenen Händen spielt es keine Rolle, ob zuerst der therapeutische Versuch einer Sachse-Urethrotomie oder gleich der einer primären, offenen Harnröhrenrekonstruktion gewählt wird [3]. Je nach Literatur und Zentrum wird nach mehrmaligen Harnröhrenschlitzungen aber von einer höheren Misserfolgsquote nach sekundärer Harnröhrenplastik berichtet [45]. Zusammenfassend lässt sich sagen, dass gemäss den international publizierten Daten eine Harnröhrenschlitzung nach Sachse nur bei Patienten mit bulbären und kurzstreckigen Strikturen zu empfehlen ist -denn lediglich da besteht die Aussicht auf einen anhaltenden Erfolg mit minimalem Aufwand.…”

Section: Urethrotomieunclassified

Die Harnröhrenstriktur des Mannes

Schmid¹,

Mack²,

Sulser³

2020

Urol. Prax.

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Zusammenfassung Die Harnröhrenstriktur des Mannes ist eine komplexe Erkrankung und geht mit einer signifikant eingeschränkten Lebensqualität sowie oftmals wiederkehrenden Behandlungen durch den Urologen einher. Abhängig vom Schweregrad und der Dauer seit der ersten Symptommanifestation kann sich das Krankheitsbild u. U. auch negativ auf den gesamten Harntrakt auswirken. Je nach anatomischer Lokalisation der Urethraengstelle stehen zudem unterschiedliche Therapieoptionen zur Wahl. Daher ist es entscheidend, dass der Wahl des Therapiepfads eine saubere Diagnostik und eine ganzheitliche Aufklärung mit gemeinsamer Entscheidungsfindung zwischen Patient und Arzt vorausgeht. Nur so kann, unter Berücksichtigung der individuellen Präferenzen, die richtige Behandlung gewählt und ein befriedigendes Resultat herbeigeführt werden. In diesem zweiteiligen Review wird die Urethrastriktur des Mannes von der Ätiologie über die Diagnostik bis hin zur operativen Behandlung ausgeleuchtet.

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Delayed Reconstruction of Bulbar Urethral Strictures is Associated with Multiple Interventions, Longer Strictures and More Complex Repairs

Abstract: Urethroplasty delay is common and often associated with symptomatic events managed by repeat urethral manipulations. Endoscopic treatments appear to lengthen strictures and increase the complexity of repair.

Cited by 26 publications

References 25 publications

Is There a Relationship Between Smoking and Stricture Recurrence After the Urethroplasty? a Systematic Review and Meta-Analysis

Is There a Relationship Between Smoking and Stricture Recurrence After the Urethroplasty? a Systematic Review and Meta-Analysis

Urethral Reconstruction in a Reference Center in Eastern Colombia

Die Harnröhrenstriktur des Mannes

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