Risk Factors and Timing of Early Stricture Recurrence After Urethroplasty

Liu, Joceline S.; Dong, Caroline; Gonzalez, Christopher

doi:10.1016/j.urology.2016.04.033

Cited by 26 publications

(21 citation statements)

References 18 publications

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“…A high number of dilatations were also reported (127 preoperative dilatations in 10 patients, multiple dilatations in 8, no dilatations in 6 and unknown in the remaining patients) but not assessed in our statistical evaluations. Due to the high number of prior failed treatments in the study cohort and the known correlation with stricture recurrences ( Liu et al, 2016 , Bello, 2016 , Breyer et al, 2010 , Kulkarni et al, 2012 ), the presented overall success rate is, as can be expected for urethroplasty with native oral mucosa. The subgroup analysis regarding number of prior surgeries ( Fig.…”

Section: Discussionmentioning

confidence: 88%

“…A recent meta-analysis of 10 cohort studies of buccal mucosa graft urethroplasty and end-to-end anastomosis in short segment bulbar urethral stricture reported a recurrence rate of 30% ( Yuri et al, 2016 ). The current survey, evaluated by an independent CRO, included complex penile and longer strictures ( Liu et al, 2016 , Ortega and Pena, 2009 , Bello, 2016 , Breyer et al, 2010 , Yalcinkaya et al, 2015 ), and excluded end-to end anastomosis (known to have a very high SR) ( Ortega and Pena, 2009 , Ivaz et al, 2017 ). One can therefore consider the results of our study in general accordance with buccal mucosa urethroplasty ( Yuri et al, 2016 , Chauhan et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies in urethroplasty usually were retrospective, conducted at specialized single institutions, and operations were done by well-experienced surgeons ( Liu et al, 2016 , Chauhan et al, 2016 , Barbagli et al, 2005 , Kulkarni et al, 2012 , Andrich and Mundy, 2008 ). Consequently, the reported SR was expectably high.…”

Section: Discussionmentioning

confidence: 99%

“…Urethral stricture affects up to 0.6% of the male population with significant disease burden ( Alwaal et al, 2014 , Liu et al, 2016 , Wessells et al, 2017 , Latini et al, 2014 ). Except for the guidelines of the American Urological Association, no therapeutic recommendations exist ( Wessells et al, 2017 , Latini et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

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Results of Use of Tissue-Engineered Autologous Oral Mucosa Graft for Urethral Reconstruction: A Multicenter, Prospective, Observational Trial

Ram-Liebig

Barbagli²,

Heidenreich

et al. 2017

EBioMedicine

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BackgroundHarvest of oral mucosa for urethroplasty due to urethral stricture is associated with donor-site-morbidity. We assessed functionality and safety of an authorized tissue-engineered oral mucosa graft (TEOMG) under routine practice in stricture recurrences of any etiology, location, length and severity (real-world data).Methods99 patients from eight centers with heterogenous urethroplasty experience levels were included in this prospective, non-interventional observational study. Primary and secondary outcomes were success rate (SR) and safety at 12 and 24 months.FindingsAll but one patient had ≥ 1, 77.1% (64 of 83) ≥ 2 and 31.3% (26 of 83) ≥ 4 previous surgical treatments. Pre- and postoperative mean ± SD peak flow rate (Qmax) were 8.3 ± 4.7 mL/s (n = 57) and 25.4 ± 14.7 mL/s (n = 51). SR was 67.3% (95% CI 57.6–77.0) at 12 and 58.2% (95% CI 47.7–68.7) at 24 months (conservative Kaplan Meier assessment). SR ranged between 85.7% and 0% in case of high and low surgical experience. Simple proportions of 12-month and 24-month SR for evaluable patients in all centers were 70.8% (46 of 65) and 76.9% (30 of 39). Except for one patient, no oral adverse event was reported.InterpretationsTEOMG is safe and efficient in urethroplasty.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Results of Use of Tissue-Engineered Autologous Oral Mucosa Graft for Urethral Reconstruction: A Multicenter, Prospective, Observational Trial

Ram-Liebig

Barbagli²,

Heidenreich

et al. 2017

EBioMedicine

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“…Finally, the ‘difficulty scoring’ of the sub‐processes for trainees may be of limited adequacy, as the difficulty of each step can vary from case to case dependent on the complexity of the stricture given its aetiology, length, and position in the bulbar urethra .…”

Section: Discussionmentioning

confidence: 99%

Development and content validation of the Urethroplasty Training and Assessment Tool (UTAT) for dorsal onlay buccal mucosa graft urethroplasty

et al. 2020

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ObjectivesTo develop and validate the Urethroplasty Training and Assessment Tool (UTAT) using Healthcare Failure Mode and Effect Analysis (HFMEA) for training and assessment of urology trainees learning this urethral reconstruction technique, as urethroplasty is the 'gold standard' treatment for long and recurrent urethral strictures and with a variety of techniques and a lack of standardised reconstructive curricula, there is a need for procedurespecific training tools to improve surgeon training and patient safety. Materials and MethodsThis international observational study was performed over an 11-month period. The HFMEA was used to identify and evaluate hazardous stages of urethroplasty to develop the UTAT. Hazard scores were calculated for the included steps of urethroplasty. Content validation was performed by 12 expert surgeons and multidisciplinary teams from international tertiary centres. ResultsThe HFMEA process resulted in an internationally validated UTAT. Hazard scores ≥4 and single point weaknesses were included to implement actions and outcome measures. Content validation was achieved by circulating the process map, hazard analysis table, and developed tools. Changes were implemented based on the feedback received from expert surgeons. The content validated dorsal onlay buccal mucosa graft bulbar UTAT contained five phases, 10 processes and 23 sub-processes. ConclusionsThe modular UTAT offers a comprehensive validated training tool developed via a detailed HFMEA protocol. This may be utilised to standardise the training and assessment of urology trainees.

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Effects of Anti‐Inflammatory Nanofibers on Urethral Healing

Chan

Bury

Fuller

et al. 2021

Macromolecular Bioscience

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Protracted postsurgical inflammation leading to postoperative complications remains a persistent problem in urethral reconstruction. Nanofibers in the form of peptide amphiphiles expressing anti‐inflammatory peptides (AIF‐PA) have positively modulated local inflammatory responses. Urethroplasty is performed to repair 5 mm ventral urethral defects with: uncoated small intestinal submucosa (SIS); SIS dip‐coated with AIF‐PA1 (anti‐inflammatory treatment), or SIS dip‐coated with AIF‐PA6 (control) on 12‐week‐old male Sprague Dawley rats (n = 6/group/timepoint). Animals are euthanized at 14 and 28 d postsurgery. Hematoxylin‐eosin, Masson's Trichrome, and immunohistochemistry with primary antibodies against myeloperoxidase (MPO; neutrophils), CD68, CD86, CD206 (macrophages), and proinflammatory cytokines TNFα and IL‐1β are performed. Complete urethral healing occurs in 3/6 uncoated SIS (50%), 2/6 SIS+AIF‐PA6 (33.3%), and 5/6 SIS+AIF‐PA1 (83.3%) animals at 14 d and all at 28 d. Application of AIF‐PA1 to SIS substitution urethroplasty decreases MPO+ neutrophils, CD86+ M1 proinflammatory macrophages, TNFα, and IL‐1β levels while concurrently increasing levels of CD206+ M2 proregenerative/anti‐inflammatory macrophages at the anastomoses and the regenerated tissue at the wound bed (REGEN). AIF‐PA1 treatment enhances the healing process, contributing to earlier, complete urethral healing, and increased angiogenesis. Further studies are needed to elucidate the specific mechanism of inflammatory response modulation on angiogenesis and overall urethral healing.

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Risk Factors and Timing of Early Stricture Recurrence After Urethroplasty

Cited by 26 publications

References 18 publications

Results of Use of Tissue-Engineered Autologous Oral Mucosa Graft for Urethral Reconstruction: A Multicenter, Prospective, Observational Trial

Results of Use of Tissue-Engineered Autologous Oral Mucosa Graft for Urethral Reconstruction: A Multicenter, Prospective, Observational Trial

Development and content validation of the Urethroplasty Training and Assessment Tool (UTAT) for dorsal onlay buccal mucosa graft urethroplasty

Effects of Anti‐Inflammatory Nanofibers on Urethral Healing

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