• Anterior urethral stricture
• Colgajos quirúrgicos
• Encuestas de salud
• Endoscopic procedures
• Estenosis de uretra anterior
• Health surveys
• Injertos quirúrgicos
• Procedimientos quirúrgicos endoscópicos
• Procedimientos quirúrgicos reconstructivos
• Procedimientos quirúrgicos urológicos
• Reconstructive procedures
• Surgical flaps
• Surgical grafts
• Urological surgical procedures

• one year recurrence rate
• optical internal urethrotomy
• prospective analysis
• urethral stricture

While several treatment options are available for pediatric urethral strictures, the appropriate treatment must be based on several factors. Although endoscopic visual internal urethrotomy (EVIU) could be a first-line treatment option for short pediatric urethral strictures, it is not feasible if the urethroscope cannot pass through the stricture point. Herein, we present a pediatric case of severe post-traumatic bulbous urethral stricture that was successfully treated by EVIU after securing the urethral route via interventional balloon dilatation.

A 12-year-old boy presented at our outpatient clinic with the inability to urinate. He had sustained a straddle injury three months prior. The post-void residual urine volume was 644 mL, and retrograde urethrography confirmed severe stricture of the bulbous urethra. EVIU was planned; however, the first attempt to treat the stricture failed because the urethroscope could not pass through the stricture point. The urethral route was subsequently secured via balloon dilatation of the stricture, which was performed in collaboration with specialists from the department of interventional radiology. The urethroscope was then able to pass, and the repeat EVIU was successful.

Interventional urethral balloon dilatation before EVIU may help secure the urethral route in the treatment of pediatric urethral strictures.

• Urethral stricture
• Endoscopic visual internal urethrotomy
• Urethroplasty
• Urethral balloon dilatation
• Interventional radiology
• Case report

• anterior urethral strictures
• endoscopic surgical procedures
• health care surveys
• reconstructive surgical procedures
• surgical flaps
• tissue grafts
• urologic surgical procedures

To evaluate the relation between clinically relevant stricture recurrence after first urethroplasty and prior endoscopic treatments (dilatation and/or direct visual internal urethrotomy) or intermittent self‐dilatation (ISD).

Patients with bulbar urethral strictures treated with first urethroplasty between 2011 and April 2019 were included in a prospectively gathered database with standardized follow‐up. Stricture recurrence was defined as any need for reintervention. Primary outcome was the analysis of recurrence risk after first urethroplasty in relation with the number of prior endoscopic treatments or performance of ISD. Univariate and multivariate statistical analyses were performed.

Overall, 106 patients were included with a median follow‐up of 12 months (interquartile range 8‐13]. Reintervention was necessary in 16 patients (15%). Recurrence was more prevalent in patients with ≥3 prior endoscopic treatments (28%, P = .009). No increased risk of recurrence was found in patients with 1 or 2 prior endoscopic treatments. The prevalence of prior ISD was twice as high in the stricture recurrence group (56% vs 26%, P = .014), and ISD was performed in 61% of the patients with ≥3 prior endoscopic treatments (P < .001). The number of prior endoscopic interventions and performance of ISD were no independent predictors for recurrence in the multivariable analysis.

This study shows that the risk of recurrence after first urethroplasty is increased in patients with ≥3 prior endoscopic treatments and in those who performed ISD. Patients performing ISD more often had ≥3 prior endoscopic treatments. Prior endoscopic treatment and performance of ISD were not independent predictors of stricture recurrence.

• reconstructive surgical procedures
• recurrence
• therapy
• treatment failure
• urethral stricture

• Bulbar urethral stricture
• Dorsal onlay
• Free graft augmentation urethroplasty
• Graft placement
• Ventral onlay

• BULBAR URETHRAL STRICTURE
• COST-EFFECTIVENESS ANALYSIS
• HEALTH STATUS
• LOWER URINARY TRACT SYMPTOMS
• MALE
• OUTCOME ASSESSMENT QUALITATIVE PROCESS EVALUATION
• RANDOMISED CONTROLLED TRIAL
• RECURRENCE
• URETHROPLASTY
• URETHROTOMY

• Adult
• Aged
• Cost-Benefit Analysis
• Endoscopy/adverse effects
• Endoscopy/economics
• Endoscopy/methods
• Humans
• Interviews as Topic
• Male
• Middle Aged
• Models, Economic
• Quality of Life
• Quality-Adjusted Life Years
• State Medicine
• Technology Assessment, Biomedical
• United Kingdom
• Urethral Stricture/surgery
• Urologic Surgical Procedures, Male/adverse effects
• Urologic Surgical Procedures, Male/economics
• Urologic Surgical Procedures, Male/methods

• MR/K02325X/1 Medical Research Council
• 10/57/23 Department of Health

• Endoscopic treatment
• Urethral stricture
• Urethral stricture guidelines
• Urethroplasty

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Child, Preschool
• Endoscopy/statistics & numerical data
• Endoscopy/trends
• Humans
• Infant
• Male
• Middle Aged
• Preoperative Period
• Procedures and Techniques Utilization/statistics & numerical data
• Retrospective Studies
• Urethra/surgery
• Urethral Stricture/surgery
• Urologic Surgical Procedures, Male/methods
• Young Adult

• Anterior urethral strictures
• Encuestas de salud
• Endoscopic surgical procedures
• Estenosis de uretra anterior
• Health care surveys
• Procedimientos quirúrgicos endoscópicos
• Procedimientos quirúrgicos reconstructivos
• Procedimientos quirúrgicos urológicos
• Reconstructive surgical procedures
• Urologic surgical procedures

• Adult
• Health Care Surveys
• Humans
• Male
• Middle Aged
• Practice Patterns, Physicians'
• Spain
• Urethral Stricture/diagnosis
• Urethral Stricture/surgery
• Urology

Redo-urethroplasty is a challenge for any genitourethral surgeon, with a number of techniques previously described. This systematic review aims to identify the surgical techniques described in the literature and evaluate the evidence for their effectiveness in managing recurrent urethral strictures.

A systematic review of the MEDLINE and EMBASE databases from 1945 to July 2018 was performed and the urethroplasty procedures were classified according to the site and surgical technique. Primary outcomes included success rates measured via re-stricture rates and the post-op maximum urinary flow rate. Secondary outcomes included complication rates and patient-reported quality of life.

A total of 39 identified studies met the inclusion criteria. Twenty-two studies described the use of excision and primary anastomotic urethroplasty with success rates showing wide variability (58–100%). Success rates reported according to the site of the stricture also varied: bulbar (58–100%) and posterior (69–100%) recurrent strictures. One-stage substitution urethroplasty was described in 25 studies with success rates of 18–100%, with the best outcomes reported for bulbar (58–100%) and hypospadias-related (78.6–82%) strictures. Two-stage substitution urethroplasty was described in 12 studies with the success rates of 20–100%, with the best evidence related to hypospadias-related and posterior urethral strictures. The buccal mucosa graft was the graft source with the best evidence for substitution urethroplasty (18–100%).

Trends of effectiveness were identified for redo-urethroplasty modalities in different locations. However, the current levels of evidence are limited to small observational studies, highlighting the need for further larger prospective data to evaluate different techniques used for recurrent urethral strictures.

The online version of this article (10.1007/s00345-019-02709-7) contains supplementary material, which is available to authorized users.

• Failed urethroplasty
• Redo-urethroplasty
• Repeat urethroplasty
• Urethral stricture

• R01 AG038453 NIA NIH HHS

• Endoscopic management
• Male urethral stricture disease
• Urethral stricture
• Urosurgery

The treatment of urethral strictures remains a challenging field in urology even though there are a variety of procedures to treat it at present, as no one approach is superior over another. This paper reviewed the surgical options for the management of different sites and types of anterior urethral stricture, providing a brief discussion of the controversies regarding this issue and suggesting possible future advancements. Among the existing procedures, simple dilation and direct vision internal urethrotomy are more commonly used for short urethral strictures ( <1 cm, soft and no previous intervention). Currently, urethroplasty using buccal mucosa or penile skin is the most widely adopted clinical techniques and have proved successful. Nonetheless, complications such as donor site morbidity remain problem. Tissue engineering techniques are considered as a promising solution for urethral reconstruction, but require further investigation, as does stem cell therapy.

• Anterior urethral strictures
• Tissue engineering
• Urethral reconstruction
• Urethral strictures

• Age factors
• Decision making
• Patient preference
• Socioeconomic factors
• Urethral stricture

• Adult
• Age Factors
• Aged
• Choice Behavior
• Cost Sharing
• Decision Making
• Educational Status
• Endoscopy/economics
• Endoscopy/methods
• Health Expenditures
• Humans
• Income
• Logistic Models
• Male
• Middle Aged
• Patient Preference
• Poverty
• Socioeconomic Factors
• Urethral Stricture/surgery
• Urologic Surgical Procedures/economics
• Urologic Surgical Procedures/methods

• K12 DK083021 NIDDK NIH HHS

• High-pressure balloon dilation
• Urethral stricture
• Urethrotomy

• Etiology
• Sténose de l’urètre
• Traitement
• Treatment
• Urethral strictures
• Uretroplasty
• Urétroplastie
• Étiologie

• Pelvic fracture
• Realignment
• Trauma
• Urethra
• Urethral stricture

Optical internal urethrotomy (OIU) is the most common procedure performed for short segment bulbar urethral stricture worldwide. This procedure most commonly performed using Sachse’s cold knife. Various perioperative complications of internal urethrotomy have been described in literature including bleeding, urinary tract infection, extravasation of fluid, incontinence, impotence, and recurrence of stricture. Here we report a unique complication of breakage of Sachse knife blade intraoperatively and its endoscopic management.

• Methods
• Recurrence
• Urethra

Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0–9%). Urethroplasty has a much higher chance of success (85–90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether.

• Internal Urethrotomy
• Spongiofibrosis
• Urethral stenosis
• Urethral stricture
• Urethroplasty

• Cost-effectiveness
• Urethroplasty
• Utilization

• Endoscopic urethrotomy
• Estenosis uretral
• Recidiva
• Recurrence
• Urethral stricture
• Uretrotomía endoscópica

• Internal urethrotomy
• intracorpus
• local anesthesia
• randomized
• trial
• visual internal urethrotomy

Urethral stricture disease affects many men worldwide. Traditionally, the investigation of choice has been urethrography and the management of choice has been urethrotomy/dilatation. In this review, we discuss the evidence behind the use of ultrasonography in stricture assessment. We also discuss the factors a surgeon should consider when deciding the management options with each individual patient. Not all strictures are identical and surgeons should appreciate the poor long-term results of urethrotomy/dilatation for strictures longer than 2 cm, strictures in the penile urethra, recurrent strictures, and strictures secondary to lichen sclerosus. These patients may benefit from primary urethroplasty if they have many adverse features or secondary urethroplasty after the first recurrence.

• Urethral stricture disease
• dilatation
• urethrography
• urethrotomy

Indirect measures that determine the number of reconstructive urologists in the US seem to indicate a general shortage in the number of these specially trained surgeons. This shortage may worsen in the future, as the US population continues to age and the number of urologists relative to the general population growth continues to fall. The lack of reconstructive urology expertise seems to drive an inappropriate number of urethrotomies performed in the US, most troubling in those with previous failed urethotomies in whom the subsequent urethrotomy failure rate approaches 100%. Recently increases in the number of fellowship training programs and an increased number of residency centers nationwide that graduate urologists with good basic knowledge of urethroplasty will partly ameliorate this shortage, but wide geographic regions remain without any urologic reconstruction experts.

• Reconstructive urology workforce
• manpower

Urethral stricture is a common cause of difficulty passing urine in men with prevalence of 0.5 %; about 62,000 men in the UK. The stricture is usually sited in the bulbar part of the urethra causing symptoms such as reduced urine flow. Initial treatment is typically by endoscopic urethrotomy but recurrence occurs in about 60 % of men within 2 years. The best treatment for men with recurrent bulbar stricture is uncertain. Repeat endoscopic urethrotomy opens the narrowing but it usually scars up again within 2 years requiring repeated procedures. The alternative of open urethroplasty involves surgically reconstructing the urethra, which may need an oral mucosal graft. It is a specialist procedure with a longer recovery period but may give lower risk of recurrence. In the absence of firm evidence as to which is best, individual men have to trade off the invasiveness and possible benefit of each option. Their preference will be influenced by individual social circumstances, availability of local expertise and clinician guidance. The open urethroplasty versus endoscopic urethrotomy (OPEN) trial aims to better guide the choice of treatment for men with recurrent urethral strictures by comparing benefit over 2 years in terms of symptom control and need for further treatment.

OPEN is a pragmatic, UK multicentre, randomised trial. Men with recurrent bulbar urethral strictures (at least one previous treatment) will be randomised to undergo endoscopic urethrotomy or open urethroplasty. Participants will be followed for 24 months after randomisation, measuring symptoms, flow rate, the need for re-intervention, health-related quality of life, and costs. The primary clinical outcome is the difference in symptom control over 24 months measured by the area under the curve (AUC) of a validated score. The trial has been powered at 90 % with a type I error rate of 5 % to detect a 0.1 difference in AUC measured on a 0–1 scale. The analysis will be based on all participants as randomised (intention-to-treat). The primary economic outcome is the incremental cost per quality-adjusted life year. A qualitative study will assess willingness to be randomised and hence ability to recruit to the trial.

The OPEN Trial seeks to clarify relative benefit of the current options for surgical treatment of recurrent bulbar urethral stricture which differ in their invasiveness and resources required. Our feasibility study identified that participation would be limited by patient preference and differing recruitment styles of general and specialist urologists. We formulated and implemented effective strategies to address these issues in particular by inviting participation as close as possible to diagnosis. In addition re-calculation of sample size as recruitment progressed allowed more efficient design given the limited target population and funding constraints. Recruitment is now to target.

ISRCTN98009168 Date of registration: 29 November 2012.

The online version of this article (doi:10.1186/s13063-015-1120-4) contains supplementary material, which is available to authorized users.

Objective. To determine the long-term stricture-free rate after visual internal urethrotomy following initial and follow-up urethrotomies. Methods. The records of all male patients who underwent direct visual internal urethrotomy for urethral stricture disease in our hospital between July 2004 and May 2012 were reviewed. The Kaplan-Meier method was used to analyze stricture-free probability after the first, second, third, fourth, and fifth urethrotomies. Results. A total of 301 patients were included. The overall stricture-free rate at the 36-month follow-up was 8.3% with a median time to recurrence of 10 months (95% CI of 9.5 to 10.5, range: 2–36). The stricture-free rate after one urethrotomy was 12.1% with a median time to recurrence of eight months (95% CI of 7.1–8.9). After the second urethrotomy, the stricture-free rate was 7.9% with a median time to recurrence of 10 months (95% CI of 9.3 to 10.6). After the third to fifth procedures, the stricture-free rate was 0%. There was no significant difference in the stricture-free rate between single and multiple procedures. Conclusion. The long-term stricture-free rate of visual internal urethrotomy is modest even after a single procedure.

The recent International Consultation on Urological Disease (ICUD) panel 2010 confirmed that a urethral stricture is defined as a narrowing of the urethra consequent upon ischaemic spongiofibrosis, as distinct from sphincter stenoses and a urethral disruption injury. Whenever possible, an anastomotic urethroplasty should be performed because of the higher success rate as compared to augmentation urethroplasty. There is some debate currently regarding the critical stricture length at which an anastomotic procedure can be used, but clearly the extent of the spongiofibrosis and individual anatomical factors (the length of the penis and urethra) are important, the limitation for this being extension of dissection beyond the peno-scrotal junction and the subsequent production of chordee. More recently, there has been interest in whether to excise and anastomose or to carry out a stricturotomy and reanastomosis using a Heineke-Miculicz technique. Augmentation urethroplasty has evolved towards the more extensive use of oral mucosa grafts as compared to penile skin flaps, as both flaps and grafts have similar efficacy and certainly the use of either dorsal or ventral positioning seems to provide comparable results. It is important that the reconstructive surgeon is well versed in the full range of available repair techniques, as no single method is suitable for all cases and will enable the management of any unexpected anatomical findings discovered intra-operatively.

• Bladder outflow obstruction
• Buccal mucosa graft
• Lichen sclerosus
• Pelvic fracture
• Stricture
• Urethral injury
• Urethral stricture
• Urethroplasty

• Humans
• Male
• Practice Patterns, Physicians'/trends
• Referral and Consultation
• Retrospective Studies
• Urethral Stricture/surgery
• Urologic Surgical Procedures, Male/methods

• endoscopy
• physician's practice patterns
• reconstructive surgical procedures
• urethra
• urethral stricture