Purpose: We investigated deterioration of the success rate of penile and bulbar substitution urethroplasty.
Materials And Methods: We performed a retrospective descriptive analysis of patients who underwent substitution urethroplasty between July 1994 and September 2007. Inclusion criteria included 1-stage anterior urethroplasty using penile skin or oral mucosa with a minimum of 6 years followup. Patients with posterior urethral stricture, failed hypospadias or incomplete clinical records were excluded from analysis. The primary study outcome was postoperative failure-free survival and the secondary outcome was to identify significant predictors of treatment failure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done as well as Kaplan-Meier analysis, and univariable and multivariable Cox regression analysis.
Results: A total of 359 patients were included in study. Median followup was 118 months. Of the procedures 265 (73.8%) were successful and 94 (26.2%) failed, including 91 (96.8%) within the first 5 years. Substitute tissue type (oral mucosa vs skin) was the only significant predictor on univariable analysis (HR 1.86, p = 0.005). This result was confirmed by multivariable analysis adjusting for age at surgery, stricture length and etiology, urethroplasty type and previous treatments (HR 2.26, p = 0.001).
Conclusions: Deterioration after anterior 1-stage substitution urethroplasty seems to develop within the first 5 years. Oral mucosa showed greater failure-free survival than penile skin and 1-stage penile urethroplasty showed the same success rate as bulbar urethroplasty.
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http://dx.doi.org/10.1016/j.juro.2014.02.038 | DOI Listing |
Objective: To engineer an acellular mesh to reconstruct the urethra to replace the current surgical practice of using autologous tissue grafts. Cell based approaches have shown progress. However, these have been associated with high costs and logistical challenges.
View Article and Find Full Text PDFPurpose: Urethral stricture disease (USD) incidence is estimated to be as high as 0.6-1.2%.
View Article and Find Full Text PDFRes Rep Urol
November 2024
Department of Surgery, Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of Congo.
One of the most challenging aspects of urology is restoring patency to ureters with long defects. In certain cases, it may not be feasible to perform plastic surgery on the ureter with its own tissue or bladder. In such instances, alternative solution like appendicular ureteroplasty may be promising solution.
View Article and Find Full Text PDFAsian J Urol
October 2024
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Objective: To evaluate the impact of a standardized antibiotic stewardship protocol on three subsequent endpoints in patients undergoing urethroplasty.
Methods: Men undergoing bulbar substitution urethroplasty between January 2009 and December 2016 were stratified by urine culture (UCx) at the time of surgery (sterile non-sterile) and were subjected to a standardized algorithm for urinalysis and antimicrobial therapy. We performed quantitative and qualitative exploration of UCx results and the microbial spectrum.
Kathmandu Univ Med J (KUMJ)
September 2024
Department of Urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal.
Background Urethral stricture is a challenging condition with significant socioeconomic impacts, often requiring surgical intervention such as urethroplasty. Buccal mucosa grafts (BMG) are a popular choice for substitution urethroplasty due to their favorable outcomes. This study evaluates the feasibility, safety, and acceptance of harvesting buccal mucosa grafts under local anesthesia.
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