Oral Mucosa vs. Penile Skin Flap in Substitution Urethroplasty for Anterior Urethral Strictures: A Systematic Review and Meta-Analysis

Background: The purpose of this study is to compare the effectiveness and safety of oral mucosa and penile skin flaps in the treatment of anterior urethral stricture.Methods: This meta-analysis was carried out according to the principle of preferred reporting items for systematic reviews and meta-analysis (PRISMA) and registered at PROSPERO (CRD42021277688). The Cochrane Library, PubMed, Embase, CKNI databases were searched and reviewed up to Sep 2021. Quality evaluation was performed with Newcastle-Ottawa Scale (NOS) system for non-randomized studies and Cochrane stools for randomized studies. Data synthesis was conducted with RevMan 5.4 software (Cochrane) and a Stata 15.0 environment (Stata Corpor, College Station, TX, USA).Results: After the research screening, eight studies (comprising 445 patients) were finally included in the quantitative analysis. In the success rate comparison, there was no significant difference between oral mucosa and penile skin flaps (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.80, 95% CI: 0.47–1.34, P = 0.39). There was no significant difference in the post-operative complication comparison (oral mucosa vs. penile skin flap, Mantel-Haenszel statistic [M-H] fixed model, OR: 0.68, 95% CI: 0.40–1.16, P = 0.15). However, considering that the site of oral mucosa is far from the anterior urethra, it may have advantages in operation time through simultaneous operations (oral mucosa vs. penile skin flap, MD: −40.05, 95% CI: −79.42, −0.68, P = 0.046).Conclusion: When the oral mucosal graft was used in the anterior urethra urethroplasty, it had a similar success rate and post-operative complication rate, and oral mucosa substitution had a shorter operation time. This evidence-based medical research further supports the view that oral mucosa is the preferred substitution material for the anterior urethra urethroplasty.

Tubularized urethral reconstruction using everted saphenous vein graft in a beagle model

Background A long segment stricture in the anterior urethra is a challenge in urology. We conducted a study to investigate the efficacy of anterior urethral reconstruction using an everted saphenous vein graft (SVG) in a tubular fashion. Methods Twelve male beagles were randomly divided into three groups: experimental group (n = 5), control group (n = 5) and normal group (n = 2). A 3 cm defect in the anterior urethra was created. Autologous SVG was harvested. In the experimental group, urethral defect was replaced by an everted SVG in a tubular fashion. In the control group, urethral reconstruction was performed using an uneverted SVG. Beagles in all groups received retrograde urethrography to evaluate urethral patency and were killed for histological examination 6 months after operation. Results Four beagles in the experimental group had no voiding difficulty and the other one could not void spontaneously. Retrograde urethrography showed the four beagles in experimental group had wide urethral lumens. Ether urethral stricture or fistula were detected in all animals in the control group. Histological analysis of the four beagles in the experimental group indicated the everted SVG completely integrated into the urethra. The reconstructed urethra contained a wide lumen and was completely covered by urothelium. The periurethral collagen and muscle fibers formed and were highly organized. Everted SVG showed a high ability of neovascularization. In the control group, the reconstructed segment showed a fibrotic urethral lumen where the urothelium was not intact. Only few new capillaries were formed. Conclusions Everted SVG demonstrates for a promising strategy for potential urethral stricture repair.

Urethral polyembolokoilamania: not a bread-and-butter issue

Urethral polyembolokoilamania, the self-insertion of a foreign body into the male urethra for sexual gratification and autoerotism, is an uncommon urological emergency with potentially severe consequences. We present the case of a 27-year-old male who presented to our emergency unit after apparently sustaining a penile injury during sexual intercourse. Clinically, a foreign body was thought to be palpable, extending from the mid-shaft of the penis to the penoscrotal junction. Pelvic X-rays confirmed a radiopaque penile foreign body in the region of the anterior urethra. Cystoscopy confirmed the presence of an encrusted foreign body in the anterior urethra. It noted that the surrounding mucosa was very inflamed with areas of necrosis, suggesting that the foreign body had been present in the urethra for some time. To avoid further urethral trauma, we approached the foreign body via an external urethrotomy and removed a plastic knife in three parts. The urethra was repaired over a 16F catheter. The patient had an uneventful postoperative course, and a peri-catheter urethrogram 6 weeks after the procedure showed no signs of contrast extravasation or urethral stricture.

Complete Urethral Duplication With Epispadias in a Young Man: A Case Report

A 25 year male patient presented with the complaints of passage of urine through two openings on his penis, with deformities of penis since birth. After birth his parents noticed, when he micturates, urine comes through an opening on the proximal part of dorsal surface of penis in addition to the opening on the tip of glans penis. The penis is also a bit deformed and dorsal part of corona glandis is bifid. No treatment for the anomaly was taken. At puberty his testes, scrotum and other secondary sexual characteristics developed normally. He feels sexual attractions to opposite sex and experiences nocturnal emissions periodically. His penis erects on sexual stimulations, but bends upwards and at the peak of excitement orgasm also occurs and semen comes through the ventral orthotopic opening only. General physical examination was unremarkable, but external genitalial examination, shows, two external urethral meatus – one small pit like opening at the normal orthotopic position on the tip of glans penis and another on the dorsal surface of proximal penile shaft with epispadias and exposed urethral plate distal to this.. He had also dorsal chordee and ventral hooding with dorsal bifid glans penis. He had normally developed scrotum with normal both testes . Corpora cavernosa are developed but separated proximally. Spongiosa also developed and orthotopic anterior urethra can be palpated. Other systemic examinations revealed no abnormalities. Routine investigations like urine R/E, C/S, S.creatinine, blood sugar, CBC were normal. X-ray KUB revealed small separation of pubic symphysiis. USG of whole abdomen with KUB revealed significant PVR (77cc) with features of cystitis (sediments in bladder) with no other abnormality. RGU and MCU revealed duplicated urethra –with an accessory urethra arising from bladder neck, runs above the orthotopic one along the shaft terminating at the proximal part of dorsal penile shaft. The lower orthotopic urethra is normal with no stricture or abnormality except narrowing of the distal anterior urethra and external opening. Cystogram shows normal bladder with no VUR or divarticula except thickend wall. Urethrocystopic examination after dilatation of stenosed EUM of orthotopic (ventral) urethra showed normal anterior and posterior urethra containing sphincter and verumotanum and prostatic urethra opening into the bladder neck. Then cystoscope passed through the dorsal epispadiac urethra , which showed a less developed urethra, opening into the protruding bladder neck. Urinary bladder and ureteric orifices were normal . Then excision of accessory epispadiac urethra and the urethral plate done as high as possible near to bladder neck, followed by correction of chordee by ventral plication and repair of bifid corona glandis. He had an uneventful recovery ,though having a residual dorsal chordee, which was corrected by a second operation after 18 months, when excision of residual stump of accessory dorsal urethra followed by dermal graft repair of dorsal corporal body done. Bangladesh Journal of Urology, Vol. 21, No. 1, January 2018 p.48-51

Congenital Megalourethra Associated With Urethral Duplication: A Case Report

A 28 years old male with well developed secondary sexual characteristics was admitted in BSMMU with a grossly swollen, malformed phallus and passage of urine mostly through an opening in the perineum. After birth, his parents noticed that when the baby micturates the phallus is swollen and few drops of urine comes out through the external urethral meatus but most of the urine comes out through an opening in the perineum. No treatment was taken by his parents for this complaint. At puberty his secondary sexual characteristics developed normally. He felt sexual urge towards females but his penis was not erected. At the peak of his sexual excitement, orgasm occurs with release of whitish seminal fluid which comes mostly through perineal opening. His general physical examination was unremarkable & examination of the genitalia revealed well developed scrotum. Both of the testes were normal in size, shape and consistency but the penile shaft was large and flabby, and the ventral aspect of the penis appeared as a sac with mild pseudo phimosis. Careful palpation suggested the absence of the corpus spongiosum & corpora cavernosa. Both these findings were subsequently confirmed by a duplex colour doppler study. The penis distended ventrally when he tried to micturate and the urinary stream was narrow. About 75% of urine flow evacuates through perineal opening which was located about 2 cm from anal opening in the midline ventrally. A voiding cystourethrogram revealed that whole of the anterior urethra was grossly dilated with narrowing at the bulbar part & external urerthral meatus. There was another passage (about 5 cm) from the scrotal margin up to proximal posterior urethra. Cystogram showed a bladder diverticulum at left lateral wall. An urethrocystoscopic examination revealed that just proximal to the stenosed external urethral meatus the urethra is widely dilated which seemed like a transparent fusiform sac with irrigating fluid. Whole of the anterior urethra was very thin walled with transmitting lights through it. Proximal part of the urethra near the external sphincter was grossly narrowed. Urethrocystoscope was also introduced through the abnormal urethral opening into the perineum which was located in the midline raphe of the perineal region about 2 cm from the anal verge. This urethra joined with the penile urethra distal to the external sphincter. Prostatic part of the common urethral channel was normal containing verrumontanum and a normal bladder neck. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.53-56

Ultrasonographic assessment of male anterior urethra. Description of the technique of examination and presentation of major pathologies.

During the last years the role of sonourethrography (SUG) in the assessment of anterior male urethra pathologies, has significantly increased. The investigation is easily performed, not time consuming and should be considered the imaging technique of choice for preliminary diagnosis, without exposing the patient to X-rays. In this paper we present the technique of examination and the most common pathologies in which SUG is indicated.