Development of male and female models of long urethral strictures in swine.

Background: Preclinical animal models which mimic the dimensions of long urethral strictures (>2 cm in length) encountered in the clinic are necessary to evaluate prospective graft designs for urethroplasty. The purpose of this study was to develop both male and female porcine models of long urethral strictures (∼4 cm in length) and characterize histological and functional outcomes of iatrogenic stricture formation between genders.

Methods: Focal, partial thickness urethral injuries were created over 5-6 cm long segments in male and female swine ( = 4 per gender) via electrocoagulation and the degree of stricture formation was monitored for up to 6 weeks by urethroscopy and retrograde urethrography.

Long-term follow-up suggests high satisfaction rates for bulbomembranous radiation-induced urethral stenoses treated with anastomotic urethroplasty.

Purpose: To analyze patients who underwent anastomotic urethroplasty for radiationinduced bulbomembranous urethral stricture/stenosis (RIS) due to prostate cancer treatment with up to 19 years of follow-up and assess long-term patient reported outcomes (PROMs). Long-term follow-up with the inclusion of urethroplasty specific PROMs is lacking in the available research.

Methods: Patients who underwent anastomotic urethroplasty for RIS were identified from 2002 to 2020.

Characterization of a novel rabbit model of Peyronie's disease.

Peyronie's disease (PD) is a debilitating pathology which is associated with penile curvature and erectile dysfunction due to the formation of fibrotic plaques in the penile tunica albuginea. In the present study, we developed a novel rabbit model of PD via subtunical injection of recombinant transforming growth factor (TGF)-β1 protein and characterized erectile function and histopathological endpoints following plaque formation. Ten adult male, New Zealand white rabbits were randomized into 3 experimental groups including nonsurgical controls (NSC, N = 3) and those receiving subtunical injections of vehicle (N = 3) or TGF-β1 protein (0.

Evaluation of silk fibroin-based urinary conduits in a porcine model of urinary diversion.

The primary strategy for urinary diversion in radical cystectomy patients involves incorporation of autologous gastrointestinal conduits into the urinary tract which leads to deleterious consequences including chronic infections and metabolic abnormalities. This report investigates the efficacy of an acellular, tubular bi-layer silk fibroin (BLSF) graft to function as an alternative urinary conduit in a porcine model of urinary diversion. Unilateral urinary diversion with stented BLSF conduits was executed in five adult female, Yucatan mini-swine over a 3 month period.

Urethral Stricture/Stenosis as a Complication of High Intensity Focused Ultrasound of the Prostate (HIFU): What is the Overall Patient Experience?

Objective: To analyze the location and management of urethral stricture/stenosis in patients treated with High-intensity focused ultrasound (HIFU) of the prostate as well as to describe patient reported satisfaction in these men.

Methods: Patients with a history of HIFU requesting consultation for stricture were identified from 2010 to 2020. Demographic and prior treatment data were recorded.

Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence.

Purpose: To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence.

Methods:  We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment.

Endoscopic Management of Urethral Stricture Disease and Bladder Neck Contractures.

This section aims to review general principles of endoscopic management of urethral stricture disease and posterior urethral stenosis, with a special focus on the indications for treatment and technical aspects of urethral dilation and internal incision.

Urethral Stricture Disease: Evaluation of the Male Urethra.

The diagnosis of urethral stricture disease is often made when a man with obstructive voiding symptoms undergoes flexible cystoscopy (urethroscopy). However, a more complete and definitive diagnosis is then achieved when the urethra is subsequently evaluated with a retrograde urethrogram, and in many cases, a voiding cystourethrogram (VCUG). In situations where there is stricture disease involving the meatus or fossa navicularis that prevents the passage of adult flexible cystoscope, other testing appropriate in these cases include distal urethral calibration using bougie-a-boules and possibly the advancement of a pediatric cystoscope.

Urinary and Sexual Outcomes Following Bulbar Urethroplasty-An Analysis of 2 Common Approaches.

Objective: To report success and patient reported urinary and sexual outcomes of patients who underwent anastomotic urethroplasty and dorsal buccal onlay urethroplasty.

Materials And Methods: Patients who underwent primary transecting anastomotic or dorsal buccal onlay urethroplasty for bulbar strictures at our institution between 1998 and 2015 were analyzed. Patients who had a prior urethroplasty, involvement of a different portion of the urethra, or a diagnosis of lichen sclerosis (LS) or hypospadias were excluded.

Complications of Genital Enlargement Surgery.

Introduction: The objective of genital enlargement surgery is to increase length and/or girth for cosmetic reasons; however, newer techniques have been recently reported to be associated with only minor complications in a small percentage of patients.

Aim: We aim to report the severe complications of penile augmentation surgery seen at a referral center and describe their subsequent management.

Methods: Institutional review board approval was obtained.

Evaluation and management of adult acquired buried penis.

Adult acquired buried penis represents the clinical manifestation of a wide spectrum of pathology due to a variety of etiologies. It can be related to obesity, a laxity in connective tissue, lichen sclerosis (LS), complications from penile/scrotal enlargement surgery, scrotal lymphedema, or hidradenitis suppurativa (HS). Buried penis can be associated with poor cosmesis and hygiene, voiding dysfunction, and sexual dysfunction.

Men with Anterior Urethral Strictures are Often Treated without Imaging or Discussion of all Treatment Options.

Introduction: We determined how men presenting to our institution with anterior urethral strictures and recurrent strictures after treatment were evaluated, counseled and treated.

Methods: A prospective study was performed of all patients presenting to our institution with recurrent anterior urethral stricture disease between 2011 and 2014. Outside records were reviewed and all patients were queried to determine if they had any urethral imaging before treatment, what treatment was given and what other options were discussed.

Reconstruction of Massive Localized Lymphedema of the Scrotum: Results, Complications, and Quality of Life Improvements.

Objective: To review the surgical technique, outcomes, and complications of surgical excision of massive localized lymphedema (MLL) of the scrotum, and to determine changes in weight and quality of life (QOL) after excision.

Methods: A retrospective review was performed for all patients who have undergone excision of MLL of the scrotum at our institution between 2008 and 2014. Standard baseline characteristics, complications, pre- and postoperative weight, and QOL data were recorded.

Posterior Urethral Strictures.

Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis.

Ventral and dorsal buccal grafting for 1-stage repair of complex anterior urethral strictures.

Objective: To describe our 14-year experience with a 1-stage tissue transfer urethroplasty technique.

Methods: Eighteen patients underwent reconstruction with circumferential buccal grafting. All patients had anterior urethral strictures that included segments of total or near-total obliteration not amenable to excisional or augmented anastomotic repair and intact corpus spongiosum that could serve as a graft recipient bed.

Lock-out valve to decrease catheter-associated urinary tract infections.

Patients with long-term indwelling urinary catheters are at an increased risk for urinary tract infection due to bacteriuria. Catheter-associated urinary tract infections (CAUTIs) are a significant source of morbidity and mortality in long-term care facilities as well as in ambulatory patients requiring long-term catheterization. There is increased interest in the financial impact of CAUTI as Medicare no longer provides reimbursement for nosocomial CAUTIs.

Tips for successful open surgical reconstruction of posterior urethral disruption injuries.

This article provides an overview of the open surgical management of posterior urethral disruption injuries. The discussion includes the evaluation of the patient before surgery with a focus on urethral imaging and details of posterior urethroplasty surgical technique.

Panurethral stricture after photovaporization of the prostate for benign prostatic hyperplasia.

Purpose: To report the development of panurethral stricture disease and other lower urinary tract abnormalities as a complication of photovaporization of the prostate (PVP).

Patients And Methods: We evaluated three patients who were referred for the treatment of urethral stricture disease after PVP. Evaluation included antegrade cystoscopy, urethroscopy, retrograde urethrography, and cystourethrography.

1-stage repair of obliterative distal urethral strictures with buccal graft urethral plate reconstruction and simultaneous onlay penile skin flap.

Purpose: When penile skin is available, onlay flap reconstruction is an excellent choice for 1-stage repair of complex hypospadias and strictures involving the glans, fossa navicularis and penile urethra. When the urethra is deficient circumferentially, tube flaps are an option but there is a high failure rate. We report our 8-year experience with 1-stage reconstruction using a dorsal buccal mucosa graft to reconstruct the deficient urethral plate with repair completed using an onlay penile skin flap.

Direct vision balloon dilation for the management of urethral strictures.

Urethral strictures are often initially managed with dilation using sequential metal sounds or filiform and follower dilators. While these techniques often successfully achieve at least a temporary increase to the caliber of the area of stricture, they are performed without visual guidance, and complications can include false passage and urethral perforation. We describe the first use of balloon dilator that allows the safe, controlled, and gentle and dilation of urethral strictures under direct vision.