Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease

Shaw, Nathan M.; Venkatesan, Krishnan

doi:10.1007/s11934-018-0771-6

Cited by 21 publications

(24 citation statements)

References 50 publications

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“…The 95% CI did not exceed the reference 65% success rate for men with 0-1 prior dilations in the Steenkamp and Heyns study, but did exceed the reference 10% rate for men with 2 prior dilations. 3 Secondary outcome measures demonstrated an improvement in urinary symptoms, urinary quality of life, pain scores, and uroflowmetry-specifically Qmax, and PVR. Sexual function was not significantly affected by DCB.…”

Section: Discussionmentioning

confidence: 97%

“…2 A recent review demonstrated a 90% lifetime recurrence rate, even for first time dilations, and near 100% for repeat dilations. 3 Dilation and DVIU have similar outcomes, whereas urethroplasty has the highest rate of success. 4,5,6,7 Steroid or mitomycin C (MMC) injection have been used as an adjuvant to endoscopic treatment, but results have been mixed.…”

Section: Introductionmentioning

confidence: 98%

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A drug-coated balloon treatment for urethral stricture disease: Interim results from the ROBUST I study

Virasoro¹,

DeLong²,

Mann

et al. 2020

CUAJ

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Introduction: We aimed to investigate the safety and preliminary efficacy of the OptilumeTM paclitaxel-coated balloon for the treatment of recurrent urethral stricture. Methods: Men with bulbar urethral strictures ≤2 cm with 1–4 prior endoscopic treatments were enrolled at four study sites after Ethics Committee approvals. All subjects were treated with mechanical balloon dilation or direct visualization internal urethrotomy prior to drug-coated balloon treatment. Patients were evaluated at 2–5 days, 14 days, three, six, and 12-months post-treatment. The primary safety endpoint was serious complications through 90 days post-procedure. The preliminary efficacy endpoint was anatomic success, defined as urethral lumen ≥14 Fr at 12 months. Results: A total of 53 subjects were enrolled and treated; 46 completed the 12-month followup. Forty-three percent of men had undergone >1 previous dilation; the mean for the overall study population was 1.7 prior dilations. There were no serious adverse events related to the treatment within 90 days. Anatomic success was achieved in 32/46 (70%; 95% confidence interval [CI] 54–82%) at 12 months. The 14 failures included seven cystoscopic recurrences, five retreatments, and two patients who exited the study early due to symptom recurrence. Conclusions: One-year data indicates the OptilumeTM paclitaxel-coated balloon is safe for the treatment of recurrent bulbar urethral strictures. Early efficacy results are encouraging and support further followup of these men through five years, as well as further investigation with a randomized trial.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

A drug-coated balloon treatment for urethral stricture disease: Interim results from the ROBUST I study

Virasoro¹,

DeLong²,

Mann

et al. 2020

CUAJ

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“…5 Injury of the corpus spongiosum during DVIU can also result in the development of perineal hematoma and urethral hemorrhage. 44 Peri-operative infection has been reported to significantly increase stricture recurrence. 25 Thus, DVIU should be covered by prophylactic antibiotics.…”

Section: Complications Of Dviumentioning

confidence: 99%

Endoluminal and Endoscopic Management of Urethral Stricture

Mak¹,

Lam²,

Tsu³

2020

Journal of Endoluminal Endourology

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Background and ObjectiveUrethral stricture in the male population is one the oldest described urological condition. Significant vari-ability in clinical practice means that standardized management of urethral stricture remains controversial. Since the first description of modern-day direct visual internal urethrotomy (DVIU) by Sachse in 1974, this, alongside with various endoscopic treatment techniques, continues to be by far the most commonly performed procedures for the management of urethral strictures. This article aims to summarise and review the latest literature on endoscopic management of urethral strictures. Material and MethodsWe conducted a Pubmed and Medline search to identify publications related to endoscopic management of male urethral strictures between 1980 and 2019. Preference was given to recent and larger studies. Original research articles, review articles, abstracts, and opinion articles were included. Keywords used for the search were “male urethral stricture,” “urethrotomy,” “DVIU,” “urethral dilation,” “urethral stent”, “intermittent self-catheterisation”, “mitomycin C”, “steroids”, and “urethroplasty.” Recent FindingsThe long-term efficacy of endoscopic management of urethral stricture is poor. Recent novel advances with adjunct treatment have yet to demonstrate improvement in long-term treatment success. Repeated endoluminal or endoscopic treatments, especially for long and recurrent urethral strictures, are ineffective. They appear to delay patients from receiving definitive treatments, and potentially increase complexity and decrease the success rate of any future urethral reconstructive treatment. SummaryThere is overwhelming evidence to suggest limited long-term efficacy of endoluminal or endoscopic treat-ments for urethral stricture. Novel adjunctive therapies showed promising initial results, but none have yet to demonstrate durable efficacy. Endoscopic treatment of urethral stricture disease should only be reserved for patients who are not willing to undergo reconstructive surgery, or not fit for anesthetics.

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“…3,[9][10][11] However, for many patients USD recurrence is a likely outcome of the initial procedure, particularly with endoscopic management options. Recurrence rates following endoscopic treatments range between 23 and 92%, 5,12 and are even higher with multiple endoscopic procedures, eventually approaching 100%. 6,13,14 Across all studies, risk factors for USD recurrence include stricture length, smoking, obesity, diabetes mellitus, congenital malformation such as hypospadias, presence of chronic inflammatory conditions such as lichen sclerosus (LS), and previous attempts at management, particularly with augmentation or substitution urethroplasty.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Anterior Urethral Stricture: Challenges and Solutions

Mershon¹,

Baradaran²

2021

RRU

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Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment "failures". Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

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Endoscopic Management of Urethral Stricture: Review and Practice Algorithm for Management of Male Urethral Stricture Disease

Cited by 21 publications

References 50 publications

A drug-coated balloon treatment for urethral stricture disease: Interim results from the ROBUST I study

A drug-coated balloon treatment for urethral stricture disease: Interim results from the ROBUST I study

Endoluminal and Endoscopic Management of Urethral Stricture

Recurrent Anterior Urethral Stricture: Challenges and Solutions

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