Editorial Comment from Dr Horiguchi to Risk of urethral stricture recurrence increases over time after urethroplasty

Background: Urethral stricture and its recurrence is still a major problem in male. Several procedures are present for the treatment of the disease. Lapides introduced the concept of intermittent self dilatation (ISD) which has decreased the incidence of recurrence of urethral stricture if doing properly. The aim of the this study was to report the outcomes of ISD for the treatment of urethral stricture after Filliform follower urethral dilatation (FFUD).Method: This was a prospective comparative study, conducted in the department of surgery, urology unit from March 2013 to February 2016. Total of 49 patients were enrolled and were randomly divided into Group A and Group B. In Group A, all the patients were taught ISD with Nelaton Catheter after FFUD. In group B, all patients underwent only FFUD for urethral stricture. In both groups, Foley's catheter was removed after 2 weeks of FFUD. These patients who had difficulty In passing urine or having lower urinary tract syndrome after removal of catheter, were evaluated for urethral stricture recurrency by clinical symptoms, ultrasonography, urine test for culture and sensitivity, cystoscopy/urethrogram as necessarily.Result: In Group A, 4 patients out of 20(20%)developed urethral stricture recurrency where as in Group B,18 patients out of 23 (78.26%) developed urethral stricture recurrency. Therefore, the rate of urethral stricture recurrence is significantly more in group B than the Group A (p< 0.001).Conclusion: ISD is an effective way for the prevention of urethtral stricture recurrence after FFUD. JNGMC, Vol. 14 No. 2 December 2016, Page: 38-40

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Lichen sclerosis–induced long segment anterior urethral stricture: The early outcome of one-stage repair using dorsolateral onlay buccal mucosa graft

Urologia Journal ◽

10.1177/03915603211003396 ◽

2021 ◽

pp. 039156032110033

Author(s):

Atef Fathi ◽

Omar Mohamed ◽

Osama Mahmoud ◽

Gamal A Alsagheer ◽

Ahmed M Reyad ◽

...

Keyword(s):

Success Rate ◽

Urethral Stricture ◽

Flow Rate ◽

Urine Volume ◽

Maximum Flow ◽

Maximum Flow Rate ◽

P Value ◽

Onlay Graft ◽

Voiding Symptoms ◽

Stricture Recurrence

Background: Substitution urethroplasty using buccal mucosal grafts can be performed by several approaches including ventral onlay graft, dorsal onlay graft, or ventral urethrotomy with dorsal inlay graft. Our study aims to evaluate the surgical outcome of dorsolateral buccal mucosal graft for long segment anterior urethral stricture >6 cm in patients with Lichen sclerosus (LS). Methods: A retrospective study included patients who underwent repair for long segment anterior urethral stricture >6 cm due to LS between January 2013 and April 2019. All patients were followed-up at 3, 6, 9, and 12 months postoperatively and then yearly by clinical symptoms, uroflowmetry, and calculation of post-void residual urine volume. Retrograde urethrogram was requested for patients with voiding symptoms or decreased maximum flow rate. Stricture recurrence that required subsequent urethrotomy or urethroplasty was considered failure. The success rate and surgical complications were collected and analyzed. Results: Thirty patients were identified. The median age (range) was 39 (25–61) years and a median (range) stricture length was 8 (6–14) cm. Most of postoperative complications were of minor degree. The success rate at median follow-up of 15 (12–24) months was 86.5%. The median maximum flow rate increased significantly from 6 (2–11) ml/s preoperatively to 18 (range: 6–23) ml/s at the 6th month ( p value < 0.001). Conclusion: Dorsolateral buccal mucosal grafts urethroplasty for long anterior urethral stricture caused by LS has a high success rate and low risk of complications including stricture recurrence.

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Editorial Comment from Dr Takao to Buccal epithelium Expanded and Encapsulated in Scaffold‐Hybrid Approach to Urethral Stricture (BEES‐HAUS) procedure: A novel cell therapy‐based pilot study

International Journal of Urology ◽

10.1111/iju.13884 ◽

2018 ◽

Vol 26 (2) ◽

pp. 258-259

Author(s):

Tetsuya Takao

Keyword(s):

Pilot Study ◽

Cell Therapy ◽

Editorial Comment ◽

Urethral Stricture ◽

Hybrid Approach ◽

Buccal Epithelium

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The International Prostate Symptom Score (IPSS) Is an Inadequate Tool to Screen for Urethral Stricture Recurrence After Anterior Urethroplasty

Urology ◽

10.1016/j.urology.2016.04.006 ◽

2016 ◽

Vol 95 ◽

pp. 197-201 ◽

Cited By ~ 11

Author(s):

Christopher A. Tam ◽

Sean P. Elliott ◽

Bryan B. Voelzke ◽

Jeremy B. Myers ◽

Alex J. Vanni ◽

...

Keyword(s):

Symptom Score ◽

Urethral Stricture ◽

International Prostate Symptom Score ◽

Stricture Recurrence

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Buccal Mucosal Graft Urethroplasty as Primary Repair Has Significantly Better Outcome Than After Failed Dviu Cases- a Clinical Trial

Bangladesh Journal of Urology ◽

10.3329/bju.v21i1.49742 ◽

2020 ◽

Vol 21 (1) ◽

pp. 3-7

Author(s):

Hasina Sadia Khan ◽

AKM Anwarul Islam ◽

AKM Khurshidul Alam ◽

Mohammad Salahuddin Faruque ◽

Ismat Jahan ◽

...

Keyword(s):

Clinical Trial ◽

Urethral Stricture ◽

Flow Rate ◽

Primary Repair ◽

Urine Flow ◽

Control Group ◽

Study Group ◽

Short Segment ◽

Buccal Mucosal Graft ◽

Stricture Recurrence

Introduction: Direct Visual Internal Urethrotomy (DVIU) is the most commonly used technique for short segment bulbar urethral stricture till date. But it has a high failure and recurrence rate. On the other hand, urethroplasty is regarded as the gold standard treatment for urethral stricture. Moreover, for bulbar urethral stricture, usually more than 3cm stricture are treated with substitution urethroplasty. Current practice for short segment bulbar urethral stricture is multiple sessions of DVIU and then buccal mucosal graft (BMG) urethroplasty if they fail. But repeated DVIU make the stricture segment longer and more fibrotic. Considering the morbidities following repeated DVIU, this prospective clinical trial has been designed to compare the outcome of BMG urethroplasty after failed urethrotomy versus primary repair. Objective: To determine stricture recurrence, PVR and flow of urine in between primary BMG urethroplasty group and after failed DVIU group. Patients and Methods: The present study was conducted in the department of Urology, BSMMU between July’15 - February’17. Patients of short segment bulbar urethral stricture between 1.5- 3 cm without any previous DVIU were enrolled as study group(n=22) and patients with history of failed DVIU were included as control group(n=22). All the patients were followed upto 12 months after BMG urethroplasty and recurrence of stricture (by RGU and MCU), PVR and maximum urine flow rate (Qmax) in between two groups were compared. Results: The stricture recurrence rate was found significantly higher in control group than in the study group (p=0.042). The study group showed highly significant (0.000) decrease in post-operative PVR and significant (0.009) increase in post operative maximum urine flow rate than the control group as was assumed in the hypothesis. Conclusion: The present study propose that BMG urethroplasty as primary repair for bulbar urethral stricture within a length of 1.5-3 cm in younger age group (upto 45 years ) is very effective than BMG urethroplasty after failed DVIU cases. But long term multicentric trial is needed to further comment. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.3-7

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ROLE OF INTERMITTENT SELF DILATATION IN THE PREVENTION OF URETHRAL STRICTURE RECURRENCE AFTER DIRECT VISUAL INTERNAL URETHROTOMY: A RANDOMIZED CONTROLLED TRIAL

International Journal of Therapeutic Applications ◽

10.20530/ijta_33_110-118 ◽

2016 ◽

Vol 33 ◽

pp. 110-118

Author(s):

S. K. Singh ◽

C. S. Agrawal ◽

S. Agrawal ◽

N. Thapa ◽

R. S. Shah

Keyword(s):

Randomized Controlled Trial ◽

Urethral Stricture ◽

Controlled Trial ◽

Internal Urethrotomy ◽

Randomized Controlled ◽

Stricture Recurrence

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Internal urethrotomy versus plasmakinetic energy for surgical treatment of urethral stricture

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2015.2.161 ◽

2015 ◽

Vol 87 (2) ◽

pp. 161 ◽

Cited By ~ 1

Author(s):

Levent Ozcan ◽

Emre Can Polat ◽

Alper Otunctemur ◽

Efe Onen ◽

Oğuz Ozden Cebeci ◽

...

Keyword(s):

Surgical Treatment ◽

Urethral Stricture ◽

Maximum Flow ◽

Clinical History ◽

Internal Urethrotomy ◽

Urethral Strictures ◽

Cold Knife ◽

Group 2 ◽

Stricture Recurrence ◽

Group 1

Purpose: we aimed to compare the longterm outcome of surgical treatment of urethral stricture with the internal urethrotomy and plasmakinetic energy. Material and Methods: 60 patients, who have been operated due to urethral stricture were enrolled in our clinic. None of the patients had a medical history of urethral stricture. The urethral strictures were diagnosed by clinical history, uroflowmetry, ultrasonography and urethrography. The patients were divided two groups. Group 1 consisted of 30 patients treated with plasmakinetic urethrotomy and group 2 comprised 30 men treated with cold knife urethrotomy. Results: There were no statistically significant differences between two groups in terms of patient age, maximum flow rate (Qmax) and quality of life score (Qol) value. A statistical difference between the two groups was observed when we compared the 3rd-month uroflowmetry results. Group 1 patients had a mean postoperative Qmax value of 16,1 ± 2,3 ml/s, whereas group 2 had a mean postoperative Qmax value of 15,1 ± 2,2 ml/s (p < 0.05). In the cold knife group, 3 of 11 (27,7%) recurrences appeared within the first 3 months, whereas in the plasmakinetic group zero recurrences appeared within the first 3 months in our study. The urethral stricture recurrence rate up to the 12 month period was statistically significant for group 1 (n = 7, 23%) compared with group 2 (n = 11, 37%) (p < 0.05). Conclusion: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture.

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