Vesicourethral Anastomotic Stenosis Following Radical Prostatectomy: Risk Factors, Natural History, and Treatment Outcomes.

PURPOSE: Vesicourethral anastomotic stenosis after radical prostatectomy is a complication with significant adverse quality-of-life implications. Herein, we identify groups at risk for vesicourethral anastomotic stenosis and further characterize the natural history and treatment patterns. MATERIALS AND METHODS: Years 1987-2013 of a prospectively maintained radical prostatectomy registry were queried for patients with the diagnosis of vesicourethral anastomotic stenosis, defined as symptomatic and inability to pass a 17F cystoscope. Patients with follow-up less than 1 year, preoperative anterior urethral stricture, transurethral resection of prostate, prior pelvic radiotherapy, and metastatic disease were excluded. Logistic regression was performed to identify predictors of vesicourethral anastomotic stenosis. Functional outcomes were characterized. RESULTS: Out of 17,904 men, 851 (4.8%) developed vesicourethral anastomotic stenosis at a median of 3.4 months. Multivariable logistic regression identified associations with vesicourethral anastomotic stenosis including adjuvant radiation, BMI, prostate volume, urine leak, blood transfusion, and nonnerve-sparing techniques. Robotic approach (OR 0.39, P < .01) and complete nerve sparing (OR 0.63, P < .01) were associated with reduced vesicourethral anastomotic stenosis formation. Vesicourethral anastomotic stenosis was independently associated with 1 or more incontinence pads/d at 1 year (OR 1.76, P < .001). Of the patients treated for vesicourethral anastomotic stenosis, 82% underwent endoscopic dilation. The 1- and 5-year vesicourethral anastomotic stenosis retreatment rates were 34% and 42%, respectively. CONCLUSIONS: Patient-related factors, surgical technique, and perioperative morbidity influence the risk of vesicourethral anastomotic stenosis after radical prostatectomy. Ultimately, vesicourethral anastomotic stenosis is independently associated with increased risk of urinary incontinence. Endoscopic management is temporizing for most men, with a high rate of retreatment by 5 years.

[Analysis of risk factors of urethral stricture and urinary incontinence after transurethral resection of the prostate].

OBJECTIVE: The purpose of this study was to analyze the risk factors for predicting urethral stricture and urinary incontinence after transurethral resection of the prostate (TURP). METHODS: A retrospective study of 261 patients admitted from October 2018 to October 2022 who received TURP for benign prostatic hyperplasia (BPH) with complete postoperative follow-up data of at least 6 months. Patients were divided into urethral stricture group (n =18), non-urethral stricture group (n =243), urinary incontinence group (n = 12) and non-urethral incontinence group (n = 249) according to the presence of urethral stricture and urinary incontinence. Compared two groups of patient's age, course of the disease, hypertension, diabetes mellitus, IPSS score, prostate volume, maximum urine flow rate, whether preoperative urinary retention, total prostate specific antigen levels and whether preoperative status, placing a urinary catheter preoperative whether merger urinary tract infection, operative time, postoperative time, postoperative urine tube drawing time placing a urinary catheter, etc. Univariate and multivariate Logistic regression analyses were used to screen for independent predictors. RESULTS: The incidence of urethral stricture and urinary incontinence after TURP was 6.9% and 4.6%, respectively. Multivariate logistic regression analysis showed that diabetes mellitus (OR = 9.526, 95%CI: 2.824－32.127, P= 0.000); Preoperative urethral infection (OR = 6.500, 95%CI: 1.513－27.925, P = 0.012); Postoperative indwelling catheter time (OR = 2.063, 95%CI: 1.181－3.601, P = 0.011) was an independent risk factor for postoperative urethral stricture. Age (OR = 1.21, 95%CI: 1.027－1.425, P = 0.023); Diabetes mellitus (OR = 37.515, 95%CI: 2.615－538.170, P = 0.008); Postoperative indwelling catheter time (OR = 20.806, 95%CI: 3.090－140.080, P = 0.002) was an independent risk factor for postoperative urinary incontinence. CONCLUSIONS: Urethral stricture and urinary incontinence are common complications after TURP. Diabetes, preoperative urethral infection, and postoperative catheter indwelling time are independent risk factors for urethral stricture after TURP. Age, diabetes mellitus and postoperative catheter indwelling time were independent risk factors for postoperative urinary incontinence. Diabetes mellitus and postoperative catheter indwelling were common and independent risk factors for urethral stricture and urinary incontinence after TURP.

Efficacy of urethral reconstruction for urethral stricture associated with hypospadias surgery in adults.

OBJECTIVES: We report our experience with urethral reconstruction for hypospadias surgery-related urethral stricture in terms of surgical and patient-reported outcomes. METHODS: Twenty-nine adult males who underwent urethral reconstruction for hypospadias surgery-related urethral stricture between August 2008 and January 2022 were retrospectively reviewed. Uroflowmetry and patient-reported outcomes were evaluated at 3, 6, and 12 months, and annually thereafter. Surgical success was defined as the absence of additional procedures. Patients were asked to rate their satisfaction with urethral reconstruction as "very satisfied", "satisfied", "unsatisfied", or "very unsatisfied". RESULTS: The median patient age at referral was 43 years. The median number of previously performed hypospadias surgeries was three, and 18 patients (62.8%) had been treated with repeated transurethral procedures. The median stricture length was 54 mm (interquartile range 36-81). Performed urethral reconstruction included staged urethroplasty in 22 (75.9%), one-stage onlay augmentation in 3 (10.2%), and perineal urethrostomy in 4 (13.8%) cases. Urethral reconstruction was successful in 26 patients (89.7%) over a median postoperative period of 31 months. Patient-reported outcomes were assessed in 25 (86.2%) patients. The mean maximum flow rate, international prostate symptom score total score, international prostate symptom score quality of life score, and EuroQol-5 dimensions index significantly improved postoperatively. Twenty-three patients (92%) were "very satisfied" or "satisfied" with the outcome of their urethral reconstruction. CONCLUSIONS: Urethral reconstruction is a highly successful and patient-satisfying treatment for hypospadias surgery-related urethral stricture in adult patients. Perineal urethrostomy is a reasonable alternative for elderly patients and for patients with complicated hypospadias surgery-related urethral strictures.

The role of prostate inflammation in the pathogenesis of urethral strictures occurring after transurethral resections.

OBJECTIVE: To make an extensive evaluation about the effects of histopathological findings acquired from the resection materials of patients who underwent transurethral resection of prostate (TUR-P) due to benign prostate hyperplasia (BPH) on postoperative urethral stricture formation. MATERIALS AND METHODS: Among patients who had TUR-P due to BPH and were followed up for minimum 6 months, 51 patients detected to have urethral stricture based on endoscopic imaging were included in the urethral stricture group (Group 1) and 52 patients without urethral stricture were included in the control group (Group 2). The relation between histopathological findings of TURP materials and postoperative stricture occurrence was investigated. RESULTS: No difference in age, prostate volume, operation time and postoperative catheterization time was detected among the groups (p=0.86, p=0.13, p=0.06, p=0.32, respectively). Average time until the urethral stricture diagnosis in the group with urethral stricture was measured as 57.9±27.2 days. In our study, inflammation intensity in peri-urethral, stromal and periglandular areas and intraglandular destruction ratios were higher in urethral stricture group (Group 1) (p=0.048, p=0.3, p=0.03, p=0.01, respectively). Again, it was detected that neutrophil, plasmocyte and eosinophil cell ratios were higher in peri-urethral, stromal and periglandular areas and lymphocyte values were lower compared to the control group. CONCLUSION: Acquired data has shown that acute inflammatory attacks may be related to urethral stricture with a mostly chronic inflammation background in the prostate. During histopathological examination of prostate tissue acquired through TURP, especially high peri-urethral neutrophil, plasmocyte and eosinophil cell ratios and intra-glandular destruction ratios are important for predicting postoperative urethral stricture occurrences.

Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials.

INTRODUCTION AND OBJECTIVES: This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. MATERIALS AND METHODS: We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. RESULTS: A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p = 0.004). CONCLUSION: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.

Factors predicting the development of urethral stricture after bipolar transurethral resection of the prostate

SUMMARY OBJECTIVE: We aimed to investigate the rate of urethral stricture development, predictor factors, and the reliability following bipolar transurethral resection of the prostate. METHODS: A total of 124 patients participated in this study. Patient data were retrospectively reviewed. The patients were divided into group 1 (those who developed urethral stricture) and group 2 (those who did not develop urethral stricture). Annual checkups were performed after the postoperative months 1 and 6. The patients were checked by uroflowmetry + post-voiding residue and international index of erectile function. We evaluated the complications that developed during the perioperative period according to the Clavien system. RESULTS: Urethral stricture developed in 10.5% (13/124) of the patients. It was found that patients who underwent transurethral resection of the prostate for the second time (p=0.007), patients with a preoperative catheter or history of catheter insertion (p=0.009), patients with high preoperative median white blood cell (103) counts (p=0.013), and patients with long postoperative catheterization time had a higher rate of urethral stricture after bipolar transurethral resection of the prostate (p=0.046). No grade 4 and grade 5 complications were observed according to the Clavien system in patients. CONCLUSION: Factors such as second transurethral resection of the prostate surgery, history of preoperative catheter insertion, high postoperative white blood cell count, and long postoperative catheterization time increase the risk of urethral stricture after bipolar transurethral resection of the prostate.

Does the use of a small-size resectoscope during enucleation prevent transient urinary leakage and urethral stricture following holmium laser enucleation of the prostate?

OBJECTIVE: To investigate the effect of the use of a small-size resectoscope for enucleation during holmium laser enucleation of the prostate (HoLEP) on the prevention of transient urinary leakage (TUL) and urethral stricture (US). METHODS: One hundred patients were included in a retrospective single-center study from January 2019 to December 2020. The patients were divided into two groups according to the resectoscope size which was used for enucleation (22F in group A [n = 40] and 26F in group B [n = 60]). Patients were evaluated at 4, 12, and 24 weeks postoperatively for TUL and US. Univariate and multivariate regression analyses were implemented to assess the variables which are associated with TUL at 4 weeks. RESULTS: Baseline characteristics and perioperative data were observed to be well balanced between groups. A statistically significant higher occurrence of TUL was detected at 4 weeks in group B compared to group A (P = .018). Higher improvement in International Prostate Symptom Score (IPSS) and quality of life (QoL) was observed in group A at 4 and 12 weeks postoperatively. On univariate analysis, resectoscope size, specimen weight, and body mass index were significant predictive factors for TUL at 4 weeks. Multivariate analysis illustrated that the resectoscope size was independently associated with TUL at 4 weeks after HoLEP (odds ratio = 3.1 [1.02-9.38]). One patient in group A (2.5%) and two patients in group B (5%) demonstrated US (P = .648). CONCLUSION: Enucleation with a 22F resectoscope provides better QoL and IPSS by reducing TUL rates in the early postoperative period.

Factors Associated with Urethral and Bladder Neck Stricture After Transurethral Resection of the Prostate.

Introduction: Urethral and bladder neck stricture (U/BNS) is a complication that occurs in up to 9% of patients following transurethral resection of the prostate (TURP). The most relevant risk factors reported are prolonged surgical duration and prostatic volume. The purpose of this study is to analyze risk factors associated with the development of U/BNS following TURP. Materials and Methods: Case-control study. Population: patients who underwent TURP. Cases: patients with U/BNS following TURP, diagnosed between January 2010 and December 2018. We included patients with obstructive symptoms after TURP with clinical or radiographical evidence of U/BNS. Controls were patients who underwent TURP between January 2016 and December 2017, without evidence of stricture. Patients with history of pelvic fracture and previous U/BNS were excluded. We analyzed as risk factors age, prostatic volume, diabetes mellitus, previous use of transurethral catheter, urinary tract infection, bladder calculi, prostate cancer, previous TURP, resection time, resected volume during TURP, transoperative complications, and number of surgical procedures performed during the same event. We used chi-square or Mann-Whitney's U test for between-group comparison; association was established by odds ratios (ORs) and 95% confidence interval (CI), variables with p < 0.05 were included in the logistic regression. Results: We included 101 cases and 207 controls. Cases had lower incidence of prostate cancer, smaller prostates, less resection time during TURP, lower grams resected and prostate-specific antigen values than controls. History of transurethral catheter was more frequent in controls than cases (46% vs 29%, p = 0.004); there were no differences between groups in the other factors analyzed. On multivariate analysis, the use of a transurethral catheter was a protective factor against U/BNS (OR 0.16, 95% CI 0.064-0.442, p < 0.001). Conclusions: In this study, the use of urethral catheter before TURP is a protective factor against U/BNS.

Mortality and Urological Complications After Open Groin Hernia Repair in Local, General, and Regional Anesthesia: A Nationwide Linked Register Study.

BACKGROUND AND AIMS: The choice of anesthesia method may influence mortality and postoperative urological complications after open groin hernia repair. We aimed to investigate the association between type of anesthesia and incidence of urinary retention, urethral stricture, prostate surgery, and 1-year mortality after open groin hernia repair. MATERIALS AND METHODS: Data were linked from the Danish Hernia Database, the national patient register, and the register of causes of death. We investigated data on male adult patients receiving open groin hernia repair from 1999 to 2013 with either local anesthesia, regional anesthesia, or general anesthesia. In relation to the type of anesthesia, we compared mortality and urological complications up to 1 year postoperatively. We adjusted for covariates in a logistic regression assessing urological complications and with the Cox regression assessing mortality. RESULTS: We included 113,069 open groin hernia repairs in local anesthesia, regional anesthesia, or general anesthesia. The risk of urinary retention adjusted for covariates was higher after both general anesthesia (adjusted odds ratio = 1.64, 95% confidence interval = 1.05-2.57, p = 0.031) and regional anesthesia (odds ratio = 2.99, 95% confidence interval = 1.67-5.34, p < 0.0005) compared with local anesthesia. The adjusted risk of prostate surgery was also higher for both general anesthesia (odds ratio = 1.58, 95% confidence interval = 1.23-2.03, p < 0.0005) and regional anesthesia (odds ratio = 1.90, 95% confidence interval = 1.40-2.58, p < 0.0005) compared with local anesthesia. Type of anesthesia did not influence 1-year mortality or the risk for urethral stricture. CONCLUSION: Patients undergoing open groin hernia repair in local anesthesia experience the lowest rate of urological complications and have equally low mortality compared with patients undergoing repair in general anesthesia or regional anesthesia.

Surgical Reintervention Rates after Invasive Treatment for Lower Urinary Tract Symptoms due to Benign Prostatic Syndrome: A Comparative Study of More than 43,000 Patients with Long-Term Followup.

PURPOSE: No large-scale comparison of the 4 most established surgical approaches for lower urinary tract symptoms due to benign prostate obstruction in terms of long-term efficacy is available. We compared photoselective vaporization, laser enucleation and open simple prostatectomy to transurethral resection with regard to 5-year surgical reintervention rates. MATERIALS AND METHODS: A total of 43,041 male patients with lower urinary tract symptoms who underwent transurethral resection (34,526), photoselective vaporization (3,050), laser enucleation (1,814) or open simple prostatectomy (3,651) between 2011 and 2013 were identified in pseudonymized claims and core data of the German local health care funds and followed for 5 years. Surgical reinterventions for lower urinary tract symptoms, urethral stricture or bladder neck contracture were evaluated. Surgical approach was related to reintervention risk using the Kaplan-Meier method and Cox proportional hazards models. RESULTS: A total of 5,050 first reinterventions were performed within 5 years of primary surgery (Kaplan-Meier survival without reintervention: 87.5%, 95% CI 87.2%-87.8%). Photoselective vaporization carried an increased hazard of reintervention (HR 1.31, 95% CI 1.17-1.46, p <0.001) relative to transurethral resection, open simple prostatectomy carried a lower hazard (HR 0.43, 95% CI 0.37-0.50, p <0.001) and laser enucleation of the prostate did not differ significantly (HR 0.84, 95% CI 0.66-1.08, p=0.2). This pattern was more pronounced regarding reintervention for lower urinary tract symptom recurrence (photoselective vaporization: HR 1.52, 95% CI 1.35-1.72, p <0.001; laser enucleation of the prostate: HR 0.84, 95% CI 0.63-1.14, p=0.3; open simply prostatectomy: HR 0.38, 95% CI 0.31-0.46, p <0.001 relative to transurethral resection). CONCLUSIONS: Five-year reintervention rates of transurethral resection and laser enucleation did not differ significantly, while photoselective vaporization had a substantially higher rate. Open simple prostatectomy remains superior to transurethral resection with respect to long-term efficacy.

Transurethral resection of the prostate stricture management.

For more than nine decades, transurethral resection of the prostate remains the gold standard for the surgical treatment of lower urinary tract symptoms due to benign prostatic obstruction. The occurrence of urethral strictures after transurethral resection of the prostate is one of the major late complications and has been reported as the leading cause of iatrogenic urethral strictures in patients older than 45 years who underwent urethroplasty. Although several postulations have been proposed to explain the urethral stricture after transurethral resection of the prostate, the exact etiology of urethral stricture after TURP is still controversial. Suggested etiological factors of urethral stricture formation after transurethral resection of the prostate include infection, mechanical trauma, prolonged indwelling catheter time, use of local anesthesia, and electrical injury by a stray current. One single treatment option is not appropriate for all stricture types. The management of urethral stricture following transurethral resection of the prostate includes minimally invasive endoscopic methods, including urethral dilation and direct visual incision, or open surgical procedures with varying urethroplasty techniques. Although scientific studies focusing on urethral strictures after transurethral resection of the prostate are relatively limited and sparse, we can apply the principles of urethral stricture management before making decisions on individual stricture treatment.

Effects of poloxamer-based thermo-sensitive sol-gel agent on urethral stricture after transurethral resection of the prostate for benign prostatic hyperplasia: a multicentre, single-blinded, randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of poloxamer-based thermo-sensitive sol-gel instillation, after transurethral resection of the prostate (TURP), for preventing urethral stricture. PATIENTS AND METHODS: In all, 198 patients underwent TURP for benign prostatic hyperplasia. Recruited patients were randomly divided into two groups: groups A and B. Patients in Group A (100 patients, experimental group) received poloxamer-based thermo-sensitive sol-gel instillation and patients in the Group B (98 patients, control group) received lubricant instillation after TURP. Each patient was evaluated at 4 (V1), 12 (V2), and 24 weeks (V3) after TURP. The effectiveness of poloxamer-based thermo-sensitive sol-gel instillation was evaluated based on the International Prostate Symptom Score (IPSS), IPSS-Quality of Life (QoL), Overactive bladder questionnaire (OAB-q), maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR), and cystoscopy. RESULTS: Amongst the initial 198 participants, 80 patients in Group A and 83 in Group B completed the study. There were no significant differences in IPSS-QoL and OAB-q between the groups. However, Qmax was significantly different between groups A and B, at a mean (SD) of 18.92 (9.98) vs 15.58 (9.24) mL/s (P = 0.028) at 24 weeks after TURP. On cystoscopic examination, urethral stricture after TURP was found in two of the 80 patients in Group A and 10 of 83 in Group B (P = 0.023). CONCLUSIONS: Poloxamer-based thermo-sensitive sol-gel instillation after TURP lowered the incidence of urethral stricture.

[Results of treatment and risk factors for recurrence of iatrogenic urethral strictures in men].

AIM: Iatrogenic etiologies continue playing an increasing role in the formation of urethral strictures (US) in the industrially developed countries. Our aim was to study specific iatrogenic causative factors in the etiology of US, treatment efficacy and risk factors of their recurrence. MATERIALS AND METHODS: A total of 230 men with iatrogenic urethral strictures operated between 2008 and 2017 were included into the study group. Median age was 58.7+/-15.3 years. Inclusion criteria were presence of iatrogenic etiologic factor, open reconstruction or visual internal urethrotomy as a treatment, absence of other etiologic factors. Patients were investigated using the standard protocol. Postoperative follow up time ranged from 14 to 102 months, median 43 months. RESULTS: Average stricture length was 5,8+/-4,7 cm (1-24 cm). Primary stricture was diagnosed in 107 (46.5%) patients, while 123 (53.5%) patients with recurrent stricture were treated. Localization of urethral stricture was as following: anterior urethra (62.2%), posterior urethra (12.6%) and combined anterior/posterior strictures (25.2%). Endoscopic surgical procedures were the major cause of iatrogenic US followed by urethral catheterizations, hypospadias repair and surgical/radiation therapy of prostate cancer. The whole efficacy of surgical treatment in iatrogenic US was 84,8%. Treatment success after anastomotic urethroplasties was higher than after augmented or substitution surgical procedures. Independent risk factors for US recurrence were: 1) augmentation or substitution urethroplasty; 2) history of hypospadias repair; 3) stricture length more or equal 5,5 cm. CONCLUSION: Establishment of the particular etiologic factors may help to prevent iatrogenic US. Current methods of the US surgical management are highly effective but anastomotic urethroplasties should be preferred over augmentation and substitution techniques when possible.

Trends in urethral stricture management over two decades.

OBJECTIVES: To identify trends in the management of urethral stricture disease in Australia, assess changes in the standard of care, and examine the availability of genitourinary reconstructive surgery. METHODS: Data on eight stricture management procedures were collected online via Medicare Item Reports from the Australian Government Department of Human Services, and then matched to population data from the Australian Bureau of Statistics. A survey was disseminated via the Urological Society of Australia and New Zealand (USANZ) asking whether active members performed urethroplasty and whether this was done in a rural, regional or metropolitan setting. RESULTS: Over a 22-year period, there were 140 540 endoscopic procedures and 5136 urethroplasties, with 27.4 endoscopic procedures per urethroplasty. From 1994 to 2016, the per capita number of passage of sounds and dilatation procedures decreased by 74% and 75%, respectively, with increases in use of optical urethrotomy of 70% and in single-stage urethroplasty of 144%. Overall, the ratio of all endoscopic procedures vs urethroplasty decreased from 58.9 to 16.8. There were as few as 16 surgeons in the USANZ performing urethroplasty, with seven providing this service in regional areas. Seven had formal fellowship training. CONCLUSION: There has been a clear shift from repetitive endoscopic procedures towards urethroplasty, but the former still make up the majority of interventions. This may be explained by patients not being referred for urethroplasty earlier in the course of disease and there appears to be a gap in genitourinary reconstructive expertise in regional and rural areas.

Repair of sphincter urethral strictures preserving urinary continence: surgical technique and outcomes.

INTRODUCTION: Repair of post-TURP sphincter urethral strictures represents challenging problem, due to the risk of urinary incontinence after the repair. We described a surgical technique we use to repair these strictures preserving urinary continence in patients with incompetent bladder neck. MATERIALS AND METHODS: An observational, retrospective, study was conducted to include patients with post-TURP urethral strictures in the area of distal sphincter. We included only patients with complete clinical data and follow-up who previously underwent TURP or HOLEP or TUIP, and subsequently developed proximal bulbar urethral strictures close to the membranous urethra and the related distal urethral sphincter. Patients were included, if they were fully continent after TURP or other procedures to treat BPH. The primary outcome of the study was treatment failure, defined as the need for any post-operative instrumentation. Secondary outcome was post-urethroplasty urinary continence. Patients showing stricture recurrence or post-operative incontinence were classified as failure. RESULTS: Overall, 69 patients were included in the study. Median patient's age was 67 years; median stricture length was 4 cm. Thirty-tree patients (47.8%) underwent previous urethrotomy. Median follow-up was 52 months. Out of 69 patients, 55 (79.7%) were classified as success and 14 (20.3%) as failure. Out of the whole cohort, thus, 11/69 (16%) have a risk of recurrent strictures and 3/69 (4.3%) have incontinence. CONCLUSIONS: The use of modified ventral onlay graft urethroplasty, using particular non-aggressive steps, is a suitable surgical technique for repair of sphincter urethral stricture in patients who underwent BPH transurethral surgery, using different procedures (TURP, HOLEP, TUIP).

Buccal epithelium Expanded and Encapsulated in Scaffold-Hybrid Approach to Urethral Stricture (BEES-HAUS) procedure: A novel cell therapy-based pilot study.

OBJECTIVES: To describe the feasibility of a novel cell-based endoscopic technique using buccal epithelium, expanded and encapsulated in a thermoreversible gelation polymer scaffold for the treatment of urethral stricture. METHODS: Six male patients with bulbar urethral stricture ranging from 2.0 to 3.5 cm in length were included in this pilot study. Autologous buccal epithelial cells from a small buccal mucosal biopsy were isolated, cultured and encapsulated in thermoreversible gelation polymer scaffold, and were implanted at the stricture site after a wide endoscopic urethrotomy. RESULTS: All the patients voided well, with a mean peak flow rate of 24 mL/s. Urethroscopy carried out at 6 months showed healthy mucosa at the urethrotomy site. However, two of the six patients had recurrence at 18 and 24 months, respectively. CONCLUSIONS: This endoscopic-based Buccal epithelium Expanded and Encapsulated in Scaffold-Hybrid Approach to Urethral Stricture (BEES-HAUS) technique is a promising alternative for the open substitution buccal graft urethroplasty. It is possible to achieve the benefits of open substitution buccal urethroplasty with this endoscopic technique.

Management of post TURP strictures.

INTRODUCTION: Urethral stricture is a well-known complication after transurethral surgeries. The incidence of urethral stricture after transurethral resection of prostate (TURP) varies between 2.2 and 9.8%. Most of the cases present within 6 months of transurethral surgery. Presentation is likely with poor flow, urinary tract infection or acute retention. MATERIALS AND METHODS: A prospective study was undertaken from January 2010-June 2017 for the management of post TURP stricture. A total of 170 patients with stricture urethra due to TURP were studied. RESULTS: The age of patients was 54-87 years (mean age 67.34). The mean preop Qmax was 6.1 ml (range 0-15). The length of stricture varied from very short in the proximal bulbar to pan urethral stricture. Out of 170, 94 were treated with dorsal approach, 71 with ventral approach and 5 with simultaneous distal dorsal, proximal ventral approach. Five patients underwent endoscopic procedure. Mean BMG length was 6.25 cm (4-8) and width was 1.5 cm (1.3-1.8). Overall success rate was 82.43%. CONCLUSION: Urethral stricture is a well-known complication after transurethral surgeries. Post TURP can cause stricture at any part urethra. BMG mucosa Urethroplasty is the safe, feasible and offer long-term success in these patient and should be strongly considered over CIC and VIU. Ventral approach is best suited for proximal bulbar strictures close to membranous urethra. This is a continence preserving surgery.

[Frequency and risk factors for the development of infravesical obstructions caused by surgery of benign prostatic hyperplasia].

Benign prostatic hyperplasia (BPH) is one of the most common diseases of men elderly and senile age. The main surgical methods of treatment for BPH are transurethral resection and open prostatectomy. In some cases surgical treatment of BPH is accompanied by the development of postoperative complications leading to recurrence of the infravesical obstruction. Currently, there are no strict guidelines for selection of an optimal method of correction of late obstructive complications. This study highlights the main existing theories concerning development of urethral strictures and bladder neck contracture.

Scoping Review and Meta-analysis of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis.

PURPOSE OF REVIEW: To critically review and summarize existing literature assessing the effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of radiation-induced urologic injury. RECENT FINDINGS: Though 5 of the included 13 studies were published in the last 2-3 years, the only randomized controlled study was performed in 2012. Recent studies have confirmed the safety and efficacy of HBOT as well as identified risk factors for success vs. failure of HBOT for hemorrhagic radiation cystitis (HRC). Of the 602 patients that received HBOT for HRC, 84% had a partial or complete resolution. In the 7 studies that utilized RTOG/EORTC, 75% of patients saw an improvement in hematuria of at least one grade (out of possible 5 total). Of the 499 patients with documented follow-up, 14% experienced recurrence, with a median time to recurrence of 10 months (6 to 16.5 months).