Surgical treatment of bulbar urethral strictures: tips and tricks.

The surgical treatment of bulbar urethral strictures is still one of the most challenging reconstructive surgery problems. Bulbar urethral strictures are usually categorized as traumatic and non-traumatic strictures depending on the aetiology. The traumatic strictures are caused by trauma and they determine disruption of the urethra with obliteration of the urethral lumen, ending with fibrotic gaps between the urethral ends.

Development and content validation of the Urethroplasty Training and Assessment Tool (UTAT) for dorsal onlay buccal mucosa graft urethroplasty.

Objectives: To develop and validate the Urethroplasty Training and Assessment Tool (UTAT) using Healthcare Failure Mode and Effect Analysis (HFMEA) for training and assessment of urology trainees learning this urethral reconstruction technique, as urethroplasty is the 'gold standard' treatment for long and recurrent urethral strictures and with a variety of techniques and a lack of standardised reconstructive curricula, there is a need for procedure-specific training tools to improve surgeon training and patient safety.

Materials And Methods: This international observational study was performed over an 11-month period. The HFMEA was used to identify and evaluate hazardous stages of urethroplasty to develop the UTAT.

Anterior Urethra Reconstruction With Lateral Lingual Mucosa Harvesting Technique.

Objective: To describe a new technique for harvesting the long lingual mucosal graft (LMG) to repair the long-segment urethral strictures.

Methods: We performed a retrospective observational study of patients from whom LMGs were harvested from the lateral lining of the tongue for the long-segment anterior urethral strictures repair from 2012 to 2014 at the Shanghai Sixth People's Hospital. Patients who had 12 months minimum follow-up were included.

The spectrum of pelvic fracture urethral injuries and posterior urethroplasty in an Italian high-volume centre, from 1980 to 2013.

Objective: To describe the emergency and delayed treatment of patients with pelvic fracture urethral injuries (PFUI) presenting to an Italian high-volume centre.

Patients And Methods: In a retrospective, observational study we evaluated the spectrum of PFUI and posterior urethroplasty in an Italian high-volume centre, from 1980 to 2013. Patients requiring emergency treatment for PFUI and delayed treatment for pelvic fracture urethral defects (PFUD) were included.

Laparoscopic omentoplasty to support anastomotic urethroplasty in complex and redo pelvic fracture urethral defects.

Objective: To test the hypothesis that a new surgical technique using elaborated perineal anastomotic urethroplasty combined with laparoscopic omentoplasty for patients with complex and prior failed pelvic fracture urethral defect repair was feasible, safe, and effective.

Methods: We performed a prospective, observational, stage 2a study to observe treatment outcomes of combined perineal and laparoscopic approach for urethroplasty in patients with pelvic fracture urethral defect at a single center in Pune, India, between January 2012 and February 2013. Complex and redo patients with pelvic fracture urethral defect occurring after pelvic fracture urethral injury were included in the study.

Long-term followup and deterioration rate of anterior substitution urethroplasty.

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.

Erectile function in men with failed hypospadias repair.

Objectives: While efforts have been made to study erectile function in patients with urethral stricture, very few prior investigations have specifically assessed erectile function in men with failed hypospadias surgery. We set forth to assess the baseline erectile function of men with hypospadias failure presenting for urethroplasty as adults.

Methods: Retrospective data was analyzed on 163 adult patients with prior failed hypospadias repair who presented for urethroplasty from 2002-2007 at two sites in the United States and Italy.

Recurrent hypospadias surgery.

Objectives: To evaluate the results of various reconstructive surgical procedures in patients with failed hypospadias repair.

Methods: We performed a retrospective, observational, descriptive chart analysis of patients treated for complications after primary hypospadias repair at two tertiary European centers from 1998 to 2007. Study inclusion criteria were: patients presenting urethral, glans or corpora cavernosa defects and/or penile and genital deformities.

Harvesting oral mucosa for one-stage anterior urethroplasty.

Oral mucosa has been the most popular substitute material for urethral reconstructive surgery because it is easy to harvest, is easy to access, has a concealed donor site scar, and obviates most of the problems associated with other grafts. However, the success of using oral mucosa for urethral surgery is mainly attributed to the biological properties of this tissue. Herein, the surgical steps of harvesting oral mucosa from the inner cheek are presented with an emphasis on tips and tricks to render the process easier and more reproducible and to prevent intra and post-operative complications.

Prediction of early and late complications after oral mucosal graft harvesting: multivariable analysis from a cohort of 553 consecutive patients.

Purpose: We investigated the early and late complications after oral mucosal graft harvesting, and reported the independent predictors of outcome via multivariable analysis.

Materials And Methods: We performed a retrospective descriptive study of 553 patients from whom an oral mucosa graft was harvested for urethroplasty from single or bilateral cheeks. Patients who underwent oral mucosa harvesting from the lip, the tongue or from the cheek and lip at the same time were excluded from analysis.

Ventral oral mucosal onlay graft urethroplasty in nontraumatic bulbar urethral strictures: surgical technique and multivariable analysis of results in 214 patients.

Background: The ventral oral mucosal onlay graft is suggested in proximal bulbar strictures where the thick spongiosum provides excellent support to the graft. Some technical steps used in this technique are currently under debate in the literature.

Objective: To describe the surgical steps of this urethroplasty and investigate predictive factors of success using a multivariable logistic regression analysis.

Bulbar urethroplasty: transecting vs. nontransecting techniques.

Purpose Of Review: To transect or not to transect the bulbar urethra in nontraumatic urethral strictures still remains an issue that is open to debate. Herewith, we evaluate and compare the results of these two different options in the treatment of bulbar urethral strictures.

Recent Findings: In 404 patients, bulbar urethroplasty using transecting techniques (end-to-end anastomosis and augmented anastomotic repair) provided a success rate ranging from 90 to 98.

Current controversies in reconstructive surgery of the anterior urethra: a clinical overview.

We performed an overview of the surgical techniques suggested for the treatment of anterior urethral strictures using MEDLINE. In applying the MEDLINE search, we used the ″MeSH″ (Medical Subject Heading) and "free text" protocols. The MeSH search was conducted by combining the following terms: "urethral stricture", "flap", "graft", "oral mucosa", "urethroplasty", "urethrotomy" and "failed hypospadias".

Surgical Repair of Late Complications in Patients Having Undergone Primary Hypospadias Repair during Childhood: A New Perspective.

Background. The repair of complications in patients who had undergone hypospadias repair is still an open problem. Patients and Methods.

Controversies in urethral reconstruction.

Urethral strictures are a frequent source of lower urinary tract symptoms in men. Open urethroplasty is regarded as the gold-standard treatment for urethral stricture disease. The treatment for urethral strictures is a continually evolving process and there is renewed controversy over the best approach to take in reconstructing the urethra, since the superiority of one approach over another has not yet been clearly defined.

Histological evidence of urethral involvement in male patients with genital lichen sclerosus: a preliminary report.

Purpose: Using pathological examination we evaluated the involvement of lichen sclerosus in urethral strictures in men.

Materials And Methods: We performed an observational, descriptive, retrospective study of patients treated for genital lichen sclerosus who had at least 1 biopsy positive for lichen sclerosus. Study exclusion criteria were malignant penile lesions, incomplete data on personal charts and biopsies negative for lichen sclerosus.

[Perineal urethrostomy in complex anterior urethral stricture].

Staged urethroplasty is a well-known procedure for urethral reconstruction that had already been described by Russell in 1914 and was later popularized by Johanson, Turner-Warwick, Blandy, and Schreiter. It lends itself to the treatment of complex anterior urethral stricture in combination with lichen sclerosus, failed correction of hypospadias, fistula, via falsa, abscess, carcinoma, or previously unsuccessful urethroplasty. Perineal urethrostomy can be performed as a temporary or definitive measure.

Retrospective descriptive analysis of 1,176 patients with failed hypospadias repair.

Purpose: To our knowledge epidemiological data on the incidence of failed hypospadias repair and the number of patients seeking further surgical treatment remain unknown. We report an observational, descriptive survey of patients who were evaluated and treated for urethral stricture disease and/or penile defects after primary hypospadias repair.

Materials And Methods: We performed a retrospective observational chart analysis of patients evaluated and treated for urethral stricture disease and/or penile defects at 2 tertiary European centers from January 1998 to December 2007.