Faculty Opinions recommendation of European Association of Urology Guidelines on Urethral Stricture Disease (Part 2): Diagnosis, Perioperative Management, and Follow-up in Males.

The COVID-19 pandemic had an unprecedented effect on health systems around the world. The current situation has left its mark on all medical organisations. The principles of management of patients with various diseases have changed, and patients of urological clinics have not become an exclusion. On the whole, specialist recommend to postpone any interventions as late as possible, except for life-threatening situations that require urgent medical care In all other cases, remote consultation and treatment of patients are proposed. We prepared a review of the recommendations of the European Association of Urology (EAU) on treatment, diagnosis and follow-up of such patients during the COVID-19 pandemic.

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The Implementation of European Association of Urology Guidelines in the Management of Acute Epididymo-Orchitis

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x232026 ◽

2007 ◽

Vol 89 (8) ◽

pp. 799-803 ◽

Cited By ~ 11

Author(s):

Mary AE Garthwaite ◽

G Johnson ◽

S Lloyd ◽

I Eardley

Keyword(s):

Emergency Department ◽

European Association ◽

Implementation Strategies ◽

Sexual History ◽

Study Cohort ◽

Junior Staff ◽

Polymerase Chain ◽

European Association Of Urology ◽

Made In

INTRODUCTION Acute epididymo-orchitis is a common and increasing problem. This retrospective study reviewed whether the European Association of Urology guidelines for the management of acute epididymo-orchitis, which form the basis of this Trust's present inter-departmental guidelines, are being effectively implemented. PATIENTS AND METHODS Case notes of 53 patients attending the emergency department with acute epididymo-orchitis over a 6-month period were reviewed retrospectively. The hospital results' database was used to confirm the diagnostic tests requested on patients at the time of their initial presentation. RESULTS Of the study cohort, 26 patients were aged ≤ 35 years and 27 patients were aged > 35 years. The results demonstrated that a sexual history was documented in only 43.4% of cases. A mid-stream urine sample was sent for routine culture in 54.7% of cases whilst urine for the Chlamydia polymerase chain reaction (PCR) test was obtained in 17% and a urethral swab performed in 5.6%. Antibiotics were prescribed in 81% of cases. Of these patients, 46.5% received ciprofloxacin alone (mean age, 52 years; range, 18–87 years), 25.5% received doxycycline alone (mean age, 30 years; range, 18–45 years) and 21% received both ciprofloxacin and doxycycline (mean age, 33 years; range 18–49 years). In 26.4% of cases, verbal advice to attend a genito-urinary medicine clinic was given, whilst a formal telephone referral was made in only one case. Formal urological follow-up was arranged for only three out of 11 patients aged > 50 years. CONCLUSIONS Although a joint emergency department/urology clinical protocol for the investigation and treatment of acute epididymo-orchitis already exists within the Trust, our current management conforms to this in only a minority of cases. Many different strategies can be employed in the implementation of clinical practice guidelines and all are associated with variable degrees of success. The regular movement of junior staff through each department necessitates that the distribution of management protocols and guidelines occurs at frequent intervals throughout the year and that their implementation is continuously monitored so that, if necessary, further implementation strategies can be employed.

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The use of local therapy in preventing urethral strictures: A systematic review

PLoS ONE ◽

10.1371/journal.pone.0258256 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0258256

Author(s):

Marleen E. Jacobs ◽

Vincent F. de Kemp ◽

Maarten Albersen ◽

Laetitia M. O. de Kort ◽

Petra de Graaf

Keyword(s):

Mitomycin C ◽

Urethral Stricture ◽

Clinical Studies ◽

Local Therapy ◽

Risk Of Bias ◽

Stricture Formation ◽

Recurrence Rates ◽

Urethral Stricture Disease ◽

Stricture Recurrence

Background Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies. Objectives To provide an overview of both preclinical and clinical studies in order to investigate current level of evidence on the addition of local therapy to improve urethral stricture recurrence rates after endoscopic procedures. Methods We performed a literature search in December 2020 and August 2021 using Cochrane, Embase, PubMed, Scopus and Web of Science and identified articles through combinations of search terms for ‘urethral stricture disease’, ‘stricture formation’ and ‘local interventions’. We used the SYRCLE, RoB-2 and ROBINS-I tools to assess risk of bias across included studies. We did not perform a meta-analysis due to methodological differences between studies. Results We included 32 articles in the qualitative analysis, 20 of which were preclinical studies and 12 clinical studies. Regarding preclinical articles using an animal model, nearly all interventions showed to have a positive effect on either urethral fibrosis, urethral stricture formation and/or fibrotic protein expression levels. Here, immunosuppressants and chemotherapeutics seemed most promising for possible clinical purposes. Regarding clinical studies, mitomycin-C and hyaluronic acid and carboxymethylcellulose showed positive effects on urethral stricture recurrence rates with low to intermediate risk of bias across studies. However, the positive clinical effects of mitomycin-C and steroids seemed to decrease in studies with a longer follow-up time. Conclusion Although local adjuvant use of mitomycin-C or hyaluronic acid and carboxymethylcellulose may carry clinical potential to improve urethral structure recurrence rates after endoscopic procedures, we believe that a large, well-designed RCT with a yearlong follow-up time is necessary to identify the true clinical value.

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