Smoking is an independent risk factor for stricture recurrence after the urethroplasty: a systematic review and meta-analysis

Ma, Yucheng; Lin, Lede; Luo, Zhumei; Jin, Tao

doi:10.1590/s1677-5538.ibju.2022.0244

Cited by 6 publications

(1 citation statement)

References 28 publications

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“…In our study, patient characteristics did not interfere with the results. This may be due to the relatively small sample size as a very recent meta-analysis published in 2023 supports the fact that smoking increases the stricture recurrence risk by 1.35 fold [ 21 ]. Most studies in the literature are congruent on that infectious etiology jeopardizes the urethroplasty outcomes [ 8 10 ].…”

Section: Discussionmentioning

confidence: 99%

Inflammation indexes and machine-learning algorithm in predicting urethroplasty success

Tokuc,

Eksi,

Kayar

et al. 2024

Investig Clin Urol

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Purpose To assess the predictive capability of hematological inflammatory markers for urethral stricture recurrence after primary urethroplasty and to compare traditional statistical methods with a machine-learning-based artificial intelligence algorithm. Materials and Methods Two hundred eighty-seven patients who underwent primary urethroplasty were scanned. Ages, smoking status, comorbidities, hematological inflammatory parameters (neutrophil-lymphocyte ratios, platelet-lymphocyte ratios [PLR], systemic immune-inflammation indexes [SII], and pan-immune-inflammation values [PIV]), stricture characteristics, history of previous direct-visual internal urethrotomy, urethroplasty techniques, and grafts/flaps placements were collected. Patients were followed up for one year for recurrence and grouped accordingly. Univariate and multivariate logistic regression analyses were conducted to create a predictive model. Additionally, a machine-learning-based logistic regression analysis was implemented to compare predictive performances. p<0.05 was considered statistically significant. Results Comparative analysis between the groups revealed statistically significant differences in stricture length (p=0.003), localization (p=0.027), lymphocyte counts (p=0.008), PLR (p=0.003), SII (p=0.003), and PIV (p=0.001). In multivariate analysis, stricture length (odds ratio [OR] 1.230, 95% confidence interval [CI] 1.142–1.539, p<0.0001) and PIV (OR 1.002, 95% CI 1.000–1.003, p=0.039) were identified as significant predictors of recurrence. Classical logistic regression model exhibited a sensitivity of 0.76, specificity of 0.43 with an area under curve (AUC) of 0.65. However, the machine-learning algorithm outperformed traditional methods achieving a sensitivity of 0.80, specificity of 0.76 with a higher AUC of 0.82. Conclusions PIV and machine-learning algorithms shows promise on predicting urethroplasty outcomes, potentially leading to develop possible nomograms. Evolving machine-learning algorithms will contribute to more personalized and accurate approaches in managing urethral stricture.

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Section: Discussionmentioning

confidence: 99%

Inflammation indexes and machine-learning algorithm in predicting urethroplasty success

Tokuc,

Eksi,

Kayar

et al. 2024

Investig Clin Urol

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Delayed healing is common in in‐situ urethroplasty patients after artificial sphincter cuff erosion

Matz,

Glover,

Krug

et al. 2024

UroPrecision

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IntroductionUrethral erosion is a known complication of artificial urinary sphincter (AUS) surgery. We performed an in‐situ urethroplasty (ISU) to reduce the healing time and time to reimplantation of the AUS. We sought to assess urethral integrity one month after ISU and to identify factors associated with delayed healing in our high‐volume tertiary referral center experience.MethodsA retrospective review of our AUS database from 2009 to 2023 was conducted to identify all ISU cases. Patients were stratified as healed or non‐healed based on the absence of extravasation on voiding cystourethrogram (VCUG) obtained 4 weeks postoperatively. Background characteristics were evaluated including age, body mass index, diabetes, hypogonadism and smoking history. Operative variables included degree of erosion, location of defect, and the number of stitches required for repair.ResultsAmong 98 patients undergoing an ISU, 61 underwent VCUG at one month. Of these, 34.4% (21/61) had evidence of delayed healing on VCUG requiring prolonged catheterization. Although a higher average number of repair sutures were used in ISU, this was not significant (p = 0.381). The most common complication in both groups was urinary tract infection (UTI). Non‐healed patients had a higher rate of UTI, without significant predilection towards fistula, stricture or diverticulum. No other patient or operative characteristic was significantly different between groups.ConclusionDespite an aggressive approach to management via ISU, many patients still require prolonged catheterization after AUS erosion to ensure complete healing of the defect.

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Patient-reported outcomes after one-stage neourethral reconstruction in transmen with phalloplasty-associated strictures and fistulas

Schuettfort,

Graf,

Vetterlein

et al. 2024

World J Urol

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Introduction Urethral strictures and fistulas arising after gender-affirming surgery in transmen require meticulous management strategies. This study evaluates the safety and efficacy of urethral reconstruction and patient satisfaction post-surgery. Methods A retrospective analysis examined peri- and postoperative data from transmen undergoing urethral reconstruction for urethral fistula and/or strictures at the distal urethral anastomosis between December 2017 and April 2023. Follow-up involved clinical examinations, uroflowmetry, and voiding cystourethrography. Patient satisfaction and quality of life were assessed using USS PROM and ICIQ-S questionnaires. Results Among 25 patients, 88% (n = 23) had urethral fistulas, and 48% (n = 12) had urethral strictures. 41% of fistula patients also had strictures, while 75% of stricture patients had concurrent fistulas. Previous surgeries for fistula or stricture repair were noted in 26% of cases. Techniques for stricture included modified flap (50%), buccal oral mucosal grafting (33%), and primary anastomosis (17%). Post-operative urethrogram revealed urethral strictures in 15% (n = 3) and urinary extravasation in an equal number. Postoperative uroflow parameters showed improvement (Qmax 18 ml/s, Qave 7.9 ml, time 37 s, volume 332 ml). Perioperative complications were low (n = 6, 24%), all grade one (Clavien-Dindo). Follow-up revealed that 33% required another surgical intervention. The mean six-item LUTS score was 6.7 (SD 3.9). Mean ICIQ-S overall satisfaction score was 8.6 (SD 1.6) and outcome score was 20 (SD 2.8). Discussion Our study found a significant recurrence rate of urethral strictures and fistulas post-surgery. Despite this, patient satisfaction remains high and complications are generally low-grade, highlighting the importance of expert surgical intervention.

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Smoking is an independent risk factor for stricture recurrence after the urethroplasty: a systematic review and meta-analysis

Cited by 6 publications

References 28 publications

Inflammation indexes and machine-learning algorithm in predicting urethroplasty success

Inflammation indexes and machine-learning algorithm in predicting urethroplasty success

Delayed healing is common in in‐situ urethroplasty patients after artificial sphincter cuff erosion

Patient-reported outcomes after one-stage neourethral reconstruction in transmen with phalloplasty-associated strictures and fistulas

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