What is the evidence for the management of urethral amyloidosis? A systematic review of the literature

Abstract

What's known on the subject? and What does the study add? Urethral amyloidosis is rare and urethrotomy has been proposed as a suitable treatment option. By reviewing the literature and comparing our own experiences, we have shown urethroplasty to have good medium term outcomes in patients with urethral amyloidosis, whereas urethrotomy may lead to recurrence. OBJECTIVE Urethral amyloidosis (UA) is a rare condition which may be encountered by an urological surgeon. We reviewed the literature regarding the presentation, investigation and management of UA. PATIENTS AND METHODS A systematic review of the English literature on PubMed was conducted and we indentified 39 articles which reported 45 patients. We included our experience with four patients from our tertiary centre. RESULTS The majority of patients reported symptoms consistent with a urethral structure. Most patients were treated with urethrotomy, only two patients have been reported to have had a urethroplasty in the literature. Medium and long term outcome data is lacking for urethrotomy and urethroplasty. We found recurrence in our patients after urethromoty and incomplete resection of UA. We describe short (6 month) and medium term (18 month) outcomes in two patients who underwent augmentation urethroplasty. CONCLUSION Although urethrotomy and dilatation have been proposed in the past, we found these may still lead to disease progression and therefore urethroplasty may be the most appropriate long term management option.

Buccal mucosa graft urethroplasty in a case of urethral amyloidosis presenting with long anterior urethral stricture

“…A good medium-term outcome was reported, without recurrence up to 18 months after surgery. 3 In our case, urethral amyloidosis was presented as a long stricture of the anterior urethra, requiring surgical repair.…”

“…Only a few cases of substitution urethroplasty have been reported, with good medium-term outcomes. 3 We report the use of a buccal mucosa graft for urethroplasty in our case of localized urethral amyloidosis presenting with a long anterior urethral stricture.…”

Benefits of urethroplasty for managing urethral amyloidosis: A case report

“…Urethral amyloidosis is a worldwide rare condition and has a lower incidence rate compared with amyloidosis in the prostate or seminal vesicles ( 4 ). In the limited number of cases reported, urethral amyloidosis has occurred more often in men.…”

“…However, urologists have investigated the urethral form of amyloidosis in depth due to its similarities to the clinical appearance of urothelial carcinoma ( 5 ). Urethral amyloidosis demonstrates a benign but progressive clinical course and always leads to a urethral stricture ( 4 ). Conservative management, including urethrotomy and dilatation, has been suggested for the treatment of urethral amyloidosis; however, only a limited number of patients have been treated with urethroplasty ( 4 ).…”

“…Urethral amyloidosis demonstrates a benign but progressive clinical course and always leads to a urethral stricture ( 4 ). Conservative management, including urethrotomy and dilatation, has been suggested for the treatment of urethral amyloidosis; however, only a limited number of patients have been treated with urethroplasty ( 4 ). Analyses of the long-term outcomes of these management approaches are lacking.…”