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1.
Lasers Med Sci ; 39(1): 209, 2024 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-39101963

RESUMEN

Cold knife urethrotome was introduced in 1971 and it had an 80% success rate. New advancements in this field have shed light on the use of various lasers such as carbon dioxide, Nd: YAG, KTP, Argon, Ho: YAG, and excimer lasers. It has been observed that cold knife urethrotomy has a higher recurrence rate than laser urethrotomy, but the superiority of either treatment modality has not been established yet. Data were thoroughly searched through PubMed, Scopus, and clinicaltrials.gov. We also used clinicaltrials.gov for ongoing and published research. The data was analyzed via R studio version 2023.12.1 (oceanstorm). For dichotomous variables, Odds Ratio (OR) were used to pool data and standardized mean difference was used for continuous variables with 95% confidence intervals (CIs). A total of 14 studies including 1114 participants were included in this meta-analysis. The results of the combined analysis revealed significant relation with a mean difference of 0.99 (95% CI: 0.37; 1.62), and favored laser group. The overall results have shown the laser to have a significant favorable profile demonstrating a recurrence, Odds Ratio of 0.42 (95% CI:0.27;0.65). Patients with laser therapy had a lower risk of complication rate (OR 0.49, 95% Cl: 0.35; 0.67). All the findings obtained by the analysis in this study favour lasers significantly over the cold knife technique especially when mean Qmax, with recurrence and complications taken into account.


Asunto(s)
Uretra , Humanos , Uretra/cirugía , Terapia por Láser/métodos , Terapia por Láser/instrumentación , Terapia por Láser/efectos adversos , Resultado del Tratamiento , Estrechez Uretral/cirugía , Recurrencia , Masculino , Criocirugía/métodos , Criocirugía/instrumentación , Criocirugía/efectos adversos
2.
Cir Cir ; 92(4): 442-450, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39079241

RESUMEN

OBJECTIVE: To evaluate the relationship between heart failure (HF), chronic obstructive pulmonary disease (COPD), and smoking with the development of urethral stricture (US) by examining the patients who underwent transurethral prostate resection procedure, with and without the development of US in their follow-ups. METHODS: Among the patients who underwent transurethral resection of the prostate, 50 patients who developed US during their follow-ups formed group 1, while a total of 50 patients who did not develop US and were selected by lot formed group 2. The relationship between the patients' data on HF, COPD and smoking status and the development of US was investigated. RESULTS: The mean number of cigarettes smoked was statistically significantly high in the group with stricture (p = 0.007). Furthermore, pulmonary function test parameters of patients such as forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC were found to be statistically significantly higher in Group 2 (p < 0.001, p < 0.001, and p = 0.008, respectively). In the logistic regression analysis, being a smoker was found to be the strongest predictor (p = 0.032). CONCLUSION: Our study concluded that smoking, HF, and COPD significantly increase the risk of developing stricture after transurethral resection of the prostate.


OBJETIVO: Evaluar la relación de la insuficiencia cardiaca, la enfermedad pulmonar obstructiva crónica y el tabaquismo con el desarrollo de estenosis de uretra en pacientes sometidos a resección transuretral de próstata con y sin desarrollo de estenosis de uretra en su seguimiento. MÉTODO: Cincuenta pacientes que desarrollaron estenosis de uretra durante su seguimiento formaron el grupo 1, y 50 pacientes que no desarrollaron estenosis de uretra y fueron seleccionados por lote formaron el grupo 2. Se investigó la relación de los datos de los pacientes sobre insuficiencia cardiaca, enfermedad pulmonar obstructiva crónica y tabaquismo con el desarrollo de estenosis uretral. RESULTADOS: La media de cigarrillos fumados fue significativamente más alta en el grupo con estenosis (p = 0.007). Además, se encontró que los parámetros de las pruebas de función pulmonar de los pacientes, como FEV1, FVC y FEV1/FVC, eran significativamente más altos en el grupo 2 (p < 0.001, p < 0.001 y p = 0.008, respectivamente). CONCLUSIONES: El tabaquismo, la insuficiencia cardiaca y la enfermedad pulmonar obstructiva crónica aumentan significativamente el riesgo de desarrollar estenosis después de una resección transuretral de próstata.


Asunto(s)
Insuficiencia Cardíaca , Complicaciones Posoperatorias , Enfermedad Pulmonar Obstructiva Crónica , Fumar , Resección Transuretral de la Próstata , Estrechez Uretral , Humanos , Masculino , Estrechez Uretral/etiología , Insuficiencia Cardíaca/etiología , Fumar/efectos adversos , Anciano , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/etiología , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Resección Transuretral de la Próstata/efectos adversos , Anciano de 80 o más Años , Estudios Retrospectivos , Factores de Riesgo
3.
World J Urol ; 42(1): 443, 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39046552

RESUMEN

PURPOSE: To assess self-reported urethroplasty success rates and outcomes of recent GURS fellowship graduates and compare these data to the large body of published urethroplasty outcomes literature. METHODS: A voluntary survey was distributed from June 1 to June 30, 2023 to GURS fellowship graduates of the last 5 years. Participants were surveyed on time since graduation, operative volume, outcomes, and quoted success rates for urethroplasty. Data were then analyzed using descriptive statistics, binary logistic regression, and correlative analyses. RESULTS: We received responses from 49/101 (48.5%) GURS graduates. Five-year post-graduates were most represented (44.7%). The majority (52.2%) consider 81-90% of urethroplasty successful, without significant change with years in practice. Approximately 65% quoted excision and primary anastomosis (EPA) as > 90% successful. Over half of the respondents had performed > 60 urethroplasties since graduation. Only 31.3% of respondents reported re-intervening in > 10% of their postop patients, with a weak positive correlation between years in practice and need for re-intervention (p 0.01). Nearly 20% of respondents referred patients to an external reconstructionist. CONCLUSION: Increased length of time in practice does not result in higher reported urethroplasty success rates, counseling on successful outcomes, or rates of re-intervention and complications. Our survey highlights that the traditionally used success rates for urethroplasty may not be reflective of new graduates and lower volume reconstructive surgeons in their early career.


Asunto(s)
Becas , Uretra , Estrechez Uretral , Procedimientos Quirúrgicos Urológicos Masculinos , Humanos , Uretra/cirugía , Estrechez Uretral/cirugía , Masculino , Procedimientos Quirúrgicos Urológicos Masculinos/tendencias , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Procedimientos Quirúrgicos Urológicos Masculinos/estadística & datos numéricos , Urología/educación , Encuestas y Cuestionarios , Resultado del Tratamiento , Autoinforme , Pautas de la Práctica en Medicina/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto
4.
Asian J Androl ; 26(4): 433-438, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38887020

RESUMEN

The aim of the study was to compare the efficacy of Mathieu combined urethral plate incision (Mathieu-IP) versus onlay island flap urethroplasty in patients with distal hypospadias complicated by urethral stenosis. The clinical data of 70 patients with distal hypospadias complicated by urethral plate stenosis treated in the Department of Urology, Anhui Provincial Children's Hospital (Hefei, China), from May 2019 to May 2022, were retrospectively analyzed. Thirty-eight patients underwent Mathieu-IP (Mathieu-IP group) and 32 underwent onlay island flap urethroplasty (Onlay group). Follow-ups at 1 month, 6 months, and 12 months postoperatively assessed operative time, complications, urethral meatus morphology, and family satisfaction. The Mathieu-IP group had significantly shorter operative time (mean ± standard deviation [s.d.]: 81.58 ± 5.18 min) versus the Onlay group (mean ± s.d.: 110.75 ± 6.05 min; P < 0.05). Surgical success rates were 78.9% (Mathieu-IP group) and 75.0% (Onlay group), with no significant difference ( P > 0.05). Complications were comparable between the groups. The Mathieu-IP group resulted in a vertical slit-shaped urethral meatus in 89.5% versus 13.8% in the Onlay group ( P < 0.05). Family satisfaction with general penile appearance and skin shape showed no significant differences, but the Mathieu-IP group had higher satisfaction with meatal position ( P < 0.05). Mathieu-IP offers simplicity, safety, and shorter operative time compared to Onlay. Both the techniques effectively treat urethral plate stenosis in distal hypospadias, with reduced postoperative complications compared to tubularized incised plate urethroplasty. Mathieu-IP results in a vertical slit-shaped urethral meatus which enhances urinary stream, indicating its potential for broader adoption.


Asunto(s)
Hipospadias , Colgajos Quirúrgicos , Uretra , Estrechez Uretral , Procedimientos Quirúrgicos Urológicos Masculinos , Humanos , Masculino , Hipospadias/cirugía , Hipospadias/complicaciones , Uretra/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Estudios Retrospectivos , Estrechez Uretral/cirugía , Preescolar , Resultado del Tratamiento , Procedimientos de Cirugía Plástica/métodos , Lactante , Niño , Tempo Operativo
5.
BMC Urol ; 24(1): 121, 2024 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-38862925

RESUMEN

PURPOSE: Various complications following hypospadias surgery present distinct manifestations when examined with ultrasound. Utilizing high-frequency ultrasound, clinicians can promptly identify these complications and initiate appropriate treatment. The aim of this study is to catalogue the ultrasonographic presentations of various postoperative complications following hypospadias surgery, thereby providing a reference for ultrasonographic diagnosis. METHODS: Ultrasonic images of post-hypospadias surgery from October 1, 2015, to June 30, 2023, recorded at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, serve as the basis for this investigation. Drawing on patient clinical diagnoses, this study compiles and selects representative ultrasound images of diverse complications. RESULTS: The study encompassed a total of 121 subjects; 26 demonstrated urethral stricture on ultrasonic images, two presented local urethral dilation, six showed intraurethral hair-like structures, 17 revealed intraurethral septum, two exhibited intraurethral fold, one had urethral calculus, one displayed urethral calcification, 12 indicated intraurethral urine accumulation, and two showed urethral diverticulum. CONCLUSION: Ultrasound examination is helpful for postoperative diagnosis following hypospadias, detecting complications such as urethral stricture, urethral hair growth, and urethral diverticulum, which can help doctors choose appropriate clinical treatment strategies.


Asunto(s)
Hipospadias , Complicaciones Posoperatorias , Ultrasonografía , Humanos , Hipospadias/cirugía , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Preescolar , Lactante , Niño , Estrechez Uretral/etiología , Estrechez Uretral/diagnóstico por imagen , Adolescente , Enfermedades Uretrales/etiología , Enfermedades Uretrales/diagnóstico por imagen , Estudios Retrospectivos
6.
J Coll Physicians Surg Pak ; 34(6): 702-706, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38840355

RESUMEN

OBJECTIVE: To investigate the potential clinical benefits of mid-urethral sling (MUS) and urethral dilatation (UD) operations for the treatment of stress urinary incontinence (SUI) combined with urethral stricture. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China, from January 2017 to 2022. METHODOLOGY: Patients with Qmax <15ml/s or PVR >50ml, and video urodynamic study (VUDS) capable of confirming the presence and position of urethral stricture were included. The clinical efficacy was evaluated by International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire, maximum flow rate (Qmax), and postvoid residual (PVR) urine. ICIQ-SF, Qmax, and PVR were measured presurgery, on postoperative 2-week, and 1-month postsurgery. RESULTS: There were total 19 patients with an average age of 61.37 ± 11.28 years (range 39-84) with SUI and urethral stricture. ICIQ-SF scores were decreased significantly at one month postoperatively compared with the preoperative [5.0 (0.0, 7.0) vs. 14.0 (13.0, 15.0), p <0.001]. Qmax was increased dramatically compared with the preoperative [21.3 (14.0, 28.4) vs. 13.0 (8.7,18.0), p <0.001], and PVR was decreased remarkably than the preoperative [0.0 (0.0,0.0) vs. 0.0 (0.0,60.0), p = 0.018]. Of 19 patients primarily managed with MUS and UD, two patients experienced recurrence requiring repetitive dilation till sling excision surgery was conducted, and improvement was evident in one patient after repeating UD. CONCLUSION: The overall incidence of SUI combined with urethral stricture in women is low. With a success rate of 89.5%, MUS and UD were effective therapies for the co-existence of SUI with urethral stricture, and repeated UD can be performed safely if necessary in long-term follow-up. KEY WORDS: Stress urinary incontinence, Urethral stricture, Mid-urethral sling, Urethral dilatation.


Asunto(s)
Dilatación , Cabestrillo Suburetral , Estrechez Uretral , Incontinencia Urinaria de Esfuerzo , Humanos , Incontinencia Urinaria de Esfuerzo/cirugía , Femenino , Persona de Mediana Edad , Dilatación/métodos , Estrechez Uretral/cirugía , Estrechez Uretral/terapia , Resultado del Tratamiento , Anciano , Adulto , Urodinámica , Anciano de 80 o más Años , Uretra/cirugía , China/epidemiología , Procedimientos Quirúrgicos Urológicos/métodos , Encuestas y Cuestionarios
7.
Urologie ; 63(7): 713-720, 2024 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-38833015

RESUMEN

A urethral stricture is an abnormal narrowing of the urethra due to spongiofibrosis of the urethral mucosa and the underlying corpus spongiosum. The diagnostics include uroflowmetry, sonography and radiology. For penile strictures the success rate of endoscopic treatment is low. Therefore, urethroplasty should always be performed, preferably using oral mucosa. Depending on the complexity, reconstruction must be carried out in one or multiple stages. For short bulbous strictures endoscopic treatment can primarily be carried out. In the case of recurrence urethroplasty should be carried out. The indications for urethral reconstruction are primarily given for long bulbous strictures. Depending on the length and extent of the stricture, a scar resection and end-to-end anastomosis, non-transsecting end-to-end anastomosis or augmentation urethroplasty can be performed. Perineal urethrostomy (the so-called boutonnière procedure) is a treatment option for patients with complex strictures or for patients who want a straightforward solution.


Asunto(s)
Procedimientos de Cirugía Plástica , Uretra , Estrechez Uretral , Humanos , Estrechez Uretral/cirugía , Estrechez Uretral/diagnóstico por imagen , Masculino , Uretra/cirugía , Uretra/diagnóstico por imagen , Procedimientos de Cirugía Plástica/métodos , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Endoscopía/métodos
8.
Urol J ; 21(4): 272, 2024 06 09.
Artículo en Inglés | MEDLINE | ID: mdl-38716612

RESUMEN

We read with interest the recent paper by Hosseini et al detailing the management practice of Iranian Urologists towards the management of anterior urethral stricture disease. Please find our letter to the editor regarding this.


Asunto(s)
Estrechez Uretral , Estrechez Uretral/cirugía , Humanos , Irán , Pautas de la Práctica en Medicina/estadística & datos numéricos , Urología , Masculino
10.
Prostate Cancer Prostatic Dis ; 27(3): 537-543, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38714780

RESUMEN

INTRODUCTION AND OBJECTIVES: Urethral stricture (US) is a well-known complication after surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to evaluate the contemporary incidence of the US after different types of BPH surgery, to identify associated risk factors and to assess its management. METHODS: A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing de-identified patient records compiled between 2011 and 2022. Specific International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population characteristics and outcomes. All the most employed surgical procedures for BPH treatment were considered. Multivariable logistic regression was employed to evaluate factors associated with diagnosis of post-operative US. RESULTS: Among 274,808 patients who underwent BPH surgery, 10,918 developed post-operative US (3.97%) within 12 months. Higher incidence of US was observed following TURP (4.48%), Transurethral Incision of the Prostate (TUIP) (3.67%), Photoselective Vaporization of the Prostate (PVP) (3.92%), HoLEP/ThuLEP (3.85%), and open Simple Prostatectomy (SP) (3.21%). Lower incidence rates were observed after laparoscopic\robot-assisted SP (1.76%), Aquablation (1.59%), Prostatic Urethral Lift (PUL) (1.07%), Rezum (1.05%), and Prostatic Artery Embolization (PAE) (0.65%). Multivariable analysis showed that patients undergoing PUL, Rezum, Aquablation, PAE, and PVP were associated with a reduced likelihood of developing US compared to TURP. US required surgical treatment in 18.95% of patients, with direct visual internal urethrotomy (DVIU) and urethroplasty performed in 14.55% and 4.50% of cases, respectively. Urethral dilatation (UD) in an outpatient setting was the primary management in most cases (76.7%). CONCLUSIONS: The present analysis from a contemporary large dataset suggests that the incidence of US after BPH surgery is relatively low (<5%) and varies among procedures. Around 94% of US cases following BPH surgery are managed using minimally invasive treatment approaches such as UD and DVIU.


Asunto(s)
Bases de Datos Factuales , Complicaciones Posoperatorias , Prostatectomía , Hiperplasia Prostática , Estrechez Uretral , Humanos , Masculino , Hiperplasia Prostática/cirugía , Hiperplasia Prostática/epidemiología , Anciano , Incidencia , Estrechez Uretral/cirugía , Estrechez Uretral/etiología , Estrechez Uretral/epidemiología , Estudios Retrospectivos , Estados Unidos/epidemiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Prostatectomía/efectos adversos , Prostatectomía/métodos , Persona de Mediana Edad , Factores de Riesgo , Resección Transuretral de la Próstata/efectos adversos , Resección Transuretral de la Próstata/métodos , Anciano de 80 o más Años
11.
Medicine (Baltimore) ; 103(18): e37524, 2024 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-38701298

RESUMEN

PURPOSE: There is still controversy regarding the safety and efficacy of cold knife visual internal urethrotomy and laser incisions for the treatment of urethral stricture. This study aims to compare the results of postoperative long-term and short-term maximum urinary flow rates (Qmax), surgical time, postoperative complications, and 1-year recurrence rates between the cold knife and laser surgery. METHODS: We searched databases including Embase, PubMed, Cochrane, and Clinical Trials.gov to identify relevant literature published in English up to September 2023. We used Stata to compare various parameters. This study is registered in PROSPERO (CRD42023471634). Nine comparative experiments were conducted, involving a total of 659 participants. RESULTS: The laser group showed significantly better results compared to the cold knife group in terms of postoperative 12-month maximum urinary flow rate (mean differences [MD] 2.131; 95% [1.015, 3.249], P < .0001), postoperative bleeding (RR 0.277, 95% [0.079, 0.977], P = .046), and 1-year recurrence rate (RR 0.667, 95% [0.456, 0.976], P = .037). However, there were no significant differences in postoperative 6-month and 3-month Qmax, surgical time, urethral leakage complications, overall complications, and Visual Analog Scale (VAS) scores. CONCLUSION: The current study results suggest that laser urethral incision has greater advantages in the long-term (12 months), 1-year recurrence rate, and bleeding complications compared to cold knife urethral incision in the treatment of urethral stricture (<2 cm). Therefore, laser urethral incision may be a better choice for patients with urethral stricture.


Asunto(s)
Terapia por Láser , Uretra , Estrechez Uretral , Estrechez Uretral/cirugía , Humanos , Terapia por Láser/métodos , Terapia por Láser/efectos adversos , Uretra/cirugía , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento , Masculino , Recurrencia , Tempo Operativo , Procedimientos Quirúrgicos Urológicos Masculinos/métodos
12.
Artículo en Inglés | MEDLINE | ID: mdl-38765540

RESUMEN

Objective: To present a series of cases with our initial experience and short-term outcomes of a modified vaginal mucosal flap urethroplasty. Methods: Patients diagnosed with urethral stricture and operated by the same operative technique between January 2012 and January 2018 were followed for at least 6 months. Uroflowmetry and clinical outcomes were evaluated. Results: Nineteen patients were included with an average age of 56.4 years, mean preoperative Qmax of 5.3 ml/s, and PVR of 101.4 mL. After 6 months of the procedure, the mean Qmax improved to 14.7 mL/s (p<0.05), PVR decreased to 47.3 mL (p<0.05), and 84.2% of all patients reported improvement in clinical self-reported symptoms. There was an improvement in symptoms such as voiding effort in 84.2% of patients, weak stream (89.5%), and recurrent urinary tract infection (85.7%). The success rate (absence of symptoms and normal Qmax with no significant PVR) of the procedure was 84.2%. Conclusion: The described technique was considered effective for the treatment of female urethra stricture, with a high clinical success rate and an objective improvement of Qmax and decrease in PVR after 6 months of the procedure.


Asunto(s)
Uretra , Estrechez Uretral , Humanos , Estrechez Uretral/cirugía , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Uretra/cirugía , Adulto , Anciano , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos/métodos , Colgajos Quirúrgicos , Vagina/cirugía
13.
World J Urol ; 42(1): 348, 2024 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-38789804

RESUMEN

PURPOSE: To determine the prevalence of concomitant squamous metaplasia (SM), the initial histological change from normal urethra to urethral stricture, in bulbar urethral strictures and to investigate the associated clinical factors. METHODS: A retrospective review was conducted on 165 male patients with bulbar urethral strictures who underwent excision and primary anastomosis (EPA) between 2010 and 2020, for whom complete clinical data and excised urethral specimens were available. An experienced pathologist histologically evaluated concomitant SM in paraffin sections of the proximal end of the excised urethra blinded to the clinical data. Disease duration was calculated as the period from the initial diagnosis of urethral stricture to the date of EPA. The association between concomitant SM and clinical background was investigated. RESULTS: SM was identified in 86 (52.1%) patients. The median disease duration in patients with SM (38 months) was significantly longer than that in patients without SM (9 months, p < 0.0001). In multivariate analysis, the longer disease duration, non-traumatic stricture etiology, and failure to maintain urethral rest with urinary diversion via a suprapubic tube for more than 90 days were independent factors predicting concomitant SM. No significant difference was observed in success rates of EPA between patients with SM (93.2%) and those without SM (97.5%, p = 0.18). CONCLUSIONS: Reconstructive urologists need to be aware that concomitant SM is frequent in patients with bulbar urethral stricture, especially in those with long disease duration and those who were voiding volitionally during the period of urethral rest.


Asunto(s)
Metaplasia , Uretra , Estrechez Uretral , Procedimientos Quirúrgicos Urológicos Masculinos , Humanos , Estrechez Uretral/epidemiología , Estrechez Uretral/patología , Estrechez Uretral/cirugía , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Uretra/patología , Adulto , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Tiempo de Tratamiento
14.
Investig Clin Urol ; 65(3): 240-247, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38714514

RESUMEN

PURPOSE: To assess the predictive capability of hematological inflammatory markers for urethral stricture recurrence after primary urethroplasty and to compare traditional statistical methods with a machine-learning-based artificial intelligence algorithm. MATERIALS AND METHODS: Two hundred eighty-seven patients who underwent primary urethroplasty were scanned. Ages, smoking status, comorbidities, hematological inflammatory parameters (neutrophil-lymphocyte ratios, platelet-lymphocyte ratios [PLR], systemic immune-inflammation indexes [SII], and pan-immune-inflammation values [PIV]), stricture characteristics, history of previous direct-visual internal urethrotomy, urethroplasty techniques, and grafts/flaps placements were collected. Patients were followed up for one year for recurrence and grouped accordingly. Univariate and multivariate logistic regression analyses were conducted to create a predictive model. Additionally, a machine-learning-based logistic regression analysis was implemented to compare predictive performances. p<0.05 was considered statistically significant. RESULTS: Comparative analysis between the groups revealed statistically significant differences in stricture length (p=0.003), localization (p=0.027), lymphocyte counts (p=0.008), PLR (p=0.003), SII (p=0.003), and PIV (p=0.001). In multivariate analysis, stricture length (odds ratio [OR] 1.230, 95% confidence interval [CI] 1.142-1.539, p<0.0001) and PIV (OR 1.002, 95% CI 1.000-1.003, p=0.039) were identified as significant predictors of recurrence. Classical logistic regression model exhibited a sensitivity of 0.76, specificity of 0.43 with an area under curve (AUC) of 0.65. However, the machine-learning algorithm outperformed traditional methods achieving a sensitivity of 0.80, specificity of 0.76 with a higher AUC of 0.82. CONCLUSIONS: PIV and machine-learning algorithms shows promise on predicting urethroplasty outcomes, potentially leading to develop possible nomograms. Evolving machine-learning algorithms will contribute to more personalized and accurate approaches in managing urethral stricture.


Asunto(s)
Algoritmos , Aprendizaje Automático , Uretra , Estrechez Uretral , Humanos , Estrechez Uretral/cirugía , Masculino , Persona de Mediana Edad , Adulto , Uretra/cirugía , Recurrencia , Inflamación , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Anciano , Valor Predictivo de las Pruebas , Resultado del Tratamiento
15.
BMC Surg ; 24(1): 146, 2024 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-38734618

RESUMEN

OBJECTIVES: To retrospectively investigate and analyze the characteristics of male bulbar urethral strictures or occlusions resulting from straddle injuries caused by falling from heights and riding activities. METHODS: The study included 56 patients with a history of straddle injury, who were divided into two groups: the falling group (n = 29) and the riding group (n = 27). All patients underwent urethroscopy and X-ray urethrography, followed by urethrotomy and anastomotic procedure. Both urethral and suprapubic catheters were retained for one month postoperatively. Subsequent follow-up assessments were conducted within one month to one year after surgery. RESULTS: The clinical data of two groups were analyzed. The average ages were 40.1 ± 11.2 (falling group, aged 18-59) and 26.8 ± 4.4 (riding group, aged 19-35), P < 0.05. In the falling group, 21 cases (72.4%) had offspring, while in the riding group, only 3 cases (11.1%) had offspring, P < 0.05. The stricture segments in the falling group were predominantly located in the proximal part of the bulbar region (89.7%), whereas in the riding group they mainly found in the distal part (96.3%), P < 0.05. In terms of urethrography results, the average lengths of stricture segments were measured as 17.6 ± 2.8 mm and 15.5 ± 4.6 mm respectively, P < 0.05. During surgery, the average lengths of stricture segments were recorded as 19.0 ± 2.5 mm and 17.4 ± 6.1 mm, P > 0.05. In the falling group, 20 cases (69.0%) involved bulbocavernosus muscle injury, P < 0.05. In the riding group, 5 cases (18.5%) involved corpus cavernosum injury, P < 0.05. After one month of the operation, all cases were able to pass through the 16Fr urethroscope without any apparent urethral strictures or complications observed in urethrography results. The maximum urinary flow rate for all cases exceeded 15 ml/s. Two months and one year after the operation, all cases experienced smooth urinary flow and ejaculation without any disorders reported. 3 cases (10.3%) in the falling group and 7 cases (25.9%) in the riding group complained of urethral stretching pain during erection, P > 0.05. CONCLUSIONS: Male bulbar urethral strictures or occlusions resulting from straddle injuries associated with falling from heights and riding activities exhibit distinct characteristics, necessitating the development of a comprehensive surgical plan tailored to the specific features of each condition and the diverse age groups affected.


Asunto(s)
Estrechez Uretral , Humanos , Masculino , Estrechez Uretral/etiología , Estrechez Uretral/cirugía , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Adolescente , Adulto Joven , Accidentes por Caídas , Uretra/lesiones
16.
World J Urol ; 42(1): 324, 2024 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-38748256

RESUMEN

PURPOSE: To predict the post transurethral prostate resection(TURP) urethral stricture probability by applying different machine learning algorithms using the data obtained from preoperative blood parameters. METHODS: A retrospective analysis of data from patients who underwent bipolar-TURP encompassing patient characteristics, preoperative routine blood test outcomes, and post-surgery uroflowmetry were used to develop and educate machine learning models. Various metrics, such as F1 score, model accuracy, negative predictive value, positive predictive value, sensitivity, specificity, Youden Index, ROC AUC value, and confidence interval for each model, were used to assess the predictive performance of machine learning models for urethral stricture development. RESULTS: A total of 109 patients' data (55 patients without urethral stricture and 54 patients with urethral stricture) were included in the study after implementing strict inclusion and exclusion criteria. The preoperative Platelet Distribution Width, Mean Platelet Volume, Plateletcrit, Activated Partial Thromboplastin Time, and Prothrombin Time values were statistically meaningful between the two cohorts. After applying the data to the machine learning systems, the accuracy prediction scores for the diverse algorithms were as follows: decision trees (0.82), logistic regression (0.82), random forests (0.91), support vector machines (0.86), K-nearest neighbors (0.82), and naïve Bayes (0.77). CONCLUSION: Our machine learning models' accuracy in predicting the post-TURP urethral stricture probability has demonstrated significant success. Exploring prospective studies that integrate supplementary variables has the potential to enhance the precision and accuracy of machine learning models, consequently progressing their ability to predict post-TURP urethral stricture risk.


Asunto(s)
Algoritmos , Aprendizaje Automático , Complicaciones Posoperatorias , Resección Transuretral de la Próstata , Estrechez Uretral , Humanos , Masculino , Estrechez Uretral/cirugía , Estrechez Uretral/etiología , Estudios Retrospectivos , Anciano , Resección Transuretral de la Próstata/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Persona de Mediana Edad , Valor Predictivo de las Pruebas
17.
World J Urol ; 42(1): 342, 2024 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-38775814

RESUMEN

PURPOSE: To describe outcomes of staged-urethroplasty in complex anterior urethral strictures using full-thickness-skin-graft (FTSG) harvested from the hairless groin area, and to identify factors influencing successful outcomes. METHODS: Through retrospective chart review, we identified a total of 67 men who underwent the first-stage operation (grafting) using groin-FTSG for staged-urethroplasty to treat complex anterior urethral strictures unsuitable for one-stage urethroplasty. Among these, 59 underwent the second-stage operation (tubularization) at a median duration of 5.1-months after grafting. Patients were assessed for outcomes as scheduled after tubularization outcomes were analyzed only for 48 patients for whom ≥ 1-year follow-up data after tubularization were available. Their mean follow-up duration was 27.1 months. Success was defined as achieving physiologic voiding without requiring further procedures. RESULTS: Median stricture-length was 5.5 cm in all 67 patients. After grafting, neourethral-opening-narrowing occurred in 18. Partial graft-loss occurred in 8, of whom only 3 underwent re-grafting. The percentage of patients who achieved successful outcomes was 81.3%. Improvements in maximum-urine-flow-rate and post-void-residual-urine-volume were maintained until the last follow-up visit. A urethrocutaneous-fistula occurred in one patient, while meatal-stenosis occurred in two. On multivariate-regression-analysis, the presence of neourethral-opening-narrowing was the only predictor of non-success after tubularization. Furthermore, the presence of hypertension, longer stricture-length, and a history of prior direct-vision-internal-urethrotomy were predictors of the occurrence of neourethral-opening-narrowing. CONCLUSION: Staged-urethroplasty using groin-FTSG is well worth considering as a useful therapeutic option for complex anterior urethral strictures, with an acceptable success rate and low morbidity. The absence of neourethral-opening-narrowing after the first-stage operation leads to success.


Asunto(s)
Ingle , Trasplante de Piel , Uretra , Estrechez Uretral , Procedimientos Quirúrgicos Urológicos Masculinos , Humanos , Estrechez Uretral/cirugía , Masculino , Estudios Retrospectivos , Trasplante de Piel/métodos , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Persona de Mediana Edad , Uretra/cirugía , Adulto , Resultado del Tratamiento , Ingle/cirugía , Anciano , Adulto Joven
18.
Int Urol Nephrol ; 56(9): 2945-2954, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-38564077

RESUMEN

PURPOSE: To create a reproducible and standardized urethral stricture model in rats, evaluating both histomorphologic findings and gene expression data. In studies involving experimental animals, more standardization is needed for the creation of a urethral stricture model. METHODS: Sixteen male rats were randomized into two groups. The Sham group (n:8) underwent only a penoscrotal incision, while the stricture group (n:8) had their urethras exposed through a penoscrotal incision, followed by electrocauterization to the corpus spongiosum. On the 15th day, blood and urethral tissues were harvested for histologic and molecular analyses. Histomorphologic, immunohistochemical, and reverse transcription polymerase chain reaction analyses were performed. RESULTS: The stricture group exhibited more severe and intense spongiofibrosis, inflammation, epithelial desquamation, and congestion in vascular structures compared to the controls (p < 0.05). The urethral tissue in the stricture group showed an increased ratio of inflammation parameters, including Collagen 1A1, Collagen 3A1, elastin, Transforming growth factor ß1, α Smooth muscle actin, Platelet-derived growth factor α, and Platelet-derived growth factor ß. Transforming growth factor ß1, Platelet-derived growth factor α, and Platelet-derived growth factor ß each correlated highly with the other six parameters (r > 0.60, p < 0.05). CONCLUSION: Developing electrocoagulation-induced urethral stricture in rats is a simple, reliable, inexpensive, and reproducible. Reporting histologic data with qualitative and semi-quantitative scoring will enhance data standardization, aiding reader understanding and analysis. Transforming growth factor ß and Platelet-derived growth factor play key roles in fibrosis during stricture development. Incorporating these cytokines in urethral stricture animal model studies can demonstrate successful stenosis creation.


Asunto(s)
Modelos Animales de Enfermedad , Fibrosis , Uretra , Estrechez Uretral , Animales , Estrechez Uretral/patología , Masculino , Ratas , Uretra/patología , Factor de Crecimiento Transformador beta1/metabolismo , Colágeno Tipo III/metabolismo , Elastina/metabolismo , Ratas Sprague-Dawley , Actinas/metabolismo , Colágeno Tipo I/metabolismo , Factor de Crecimiento Derivado de Plaquetas/metabolismo , Cadena alfa 1 del Colágeno Tipo I , Distribución Aleatoria , Electrocoagulación
19.
Int J Surg ; 110(7): 4382-4392, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38573099

RESUMEN

OBJECTIVE: Urethral stricture management has posed enduring challenges in urology, demanding innovative and effective treatment modalities. This study addresses the persistent issues associated with urethral strictures, focusing on the comparative evaluation of two contemporary treatment modalities: Ho: YAG Laser Internal Urethrotomy (HIU) and Cold Knife Optical Internal Urethrotomy (CIU). METHODS: A comprehensive search of PubMed, Embase, Web of Science, Cochrane Library, and ResearchGate was conducted to identify relevant studies up to November 2023. Inclusion criteria encompassed comparative studies evaluating HIU and CIU in patients with urethral stricture. Data extraction, quality assessment, and subgroup analyses were performed using standardized methods. Outcome measures included preoperative and postoperative mean the maximum urine flow rate (Qmax), mean surgical time, recurrence rates, and perioperative complications. RESULTS: Nine articles met the inclusion criteria, and their data were analyzed using RevMan 5.4.1. Forest plots were generated for preoperative and postoperative mean Qmax, mean surgical time, recurrence rates, and perioperative complications. While postoperative mean Qmax (MD -0.06; 95% CI: -0.28-0.16; P =0.60, I2 =75%) and mean surgical time (MD 2.16; 95% CI: -1.66-5.99; P =0.27, I2 =98%) showed no significant differences between HIU and CIU, a trend towards lower recurrence rates (RR 0.71; 95% CI: 0.48-1.06; P =0.09, I2 =46%) was observed with HIU but without statistical significance. Perioperative complications, particularly bleeding (RR 0.21; 95% CI: 0.08-0.53; P =0.001, I2 =0%), favored HIU over CIU. The subanalysis indicates that for the treatment of complex urethral strictures, the two surgical methods differ in terms of mean Qmax at 6 months postoperatively (MD -2.51; 95% CI: -4.10--0.91; P =0.002, I2 =59%) and 12 months postoperatively (MD 2.62; 95% CI: 0.93-4.30; P =0.002, I2 =0%). The HIU group shows a significant decrease in recurrence rate at 12 months postoperatively (RR 0.44; 95% CI: 0.21-0.92; P =0.03, I2 =0%). For short-segment urethral strictures with a length ≤1.5 cm, CIU had a shorter operative time compared to the HIU (MD 4.49; 95% CI: 3.87-5.10; P <0.00001, I2 =44%). CONCLUSION: Overall, both interventions demonstrated similar efficacy in improving postoperative mean Qmax, mean surgical time, and recurrence rates. However, subanalysis indicates that in the short-term, CIU is more effective than HIU in improving Qmax after complex urethral stricture surgery. In long-term Qmax follow-up after surgery, HIU is significantly higher than CIU, and HIU has a low recurrence rate. In addition, for short-segment urethral stricture (≤1.5 cm), CIU requires less time. In terms of complications, HIU has a lower risk of bleeding.


Asunto(s)
Láseres de Estado Sólido , Uretra , Estrechez Uretral , Estrechez Uretral/cirugía , Humanos , Láseres de Estado Sólido/uso terapéutico , Uretra/cirugía , Resultado del Tratamiento , Masculino , Complicaciones Posoperatorias , Recurrencia , Terapia por Láser/métodos , Terapia por Láser/efectos adversos , Tempo Operativo , Procedimientos Quirúrgicos Urológicos Masculinos/métodos
20.
BMC Urol ; 24(1): 82, 2024 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-38594657

RESUMEN

OBJECTIVES: Redo surgery for pelvic fracture urethral distraction defects (PFUDDs) is still a challenge. the long urethral defect makes it difficult while the high tension increase the recurrence rate. Although certain ancillary maneuvers can relieve tension, there is no consensus or guidelines for the prediction/planning of the selection. In this study, we present our experience with developing an intraoperative guidance system to achieve tension-free urethral anastomosis. PATIENTS AND METHODS: A total of 91 recurrent PFUDD patients managed at our center between 2020 and 2022 were retrospectively analyzed. The patients underwent scar removing and urethral anastomosis. For the long defect and high-tension cases, 6 kinds of tension-relieving maneuvers were used respectively during the process of urethral anastomosis. Preoperative assessment of the urethrogram was done before surgery, while biaxial (vertical and horizontal) defect measurements were performed intraoperatively. The patients were followed-up for 12 months (8.9 ± 4.2), furthermore, recurrence and complications were analyzed. RESULTS: The overall success rate was 86.81%. The mean defect in urethrogram was 2.9 ± 1.1 cm. 27 simple anastomosis was performed when the vertical plus horizontal defect was less than 2 cm with 11.11% recurrence. 24 cavernous septum splittings were performed when the horizontal defect was greater than 2 cm with 8.33% recurrence. 21 inferior pubectomies were performed when the horizontal defect was greater than 3 cm with 19.05% recurrence. 15 ancillary distal urethra manipulations (fully distal urethral mobilization, urethral suspension and corpus cavernosa folding) were performed when the vertical defect was 3 to 4 cm with 13.33 recurrence. 4 reroutings were performed when the vertical defect was greater than 4 cm with 25.00% recurrence. CONCLUSIONS: Ancillary maneuvers are effective for reducing tension in redo urethral anastomosis. Measurement of divergent vertical and horizontal urethral defects could guide the selection of ancillary maneuvers. Combined tension-relieving maneuvers is recommended according to the defect direction and length to achieve a tension-free anastomosis.


Asunto(s)
Fracturas Óseas , Huesos Pélvicos , Estrechez Uretral , Humanos , Uretra/cirugía , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos/efectos adversos , Anastomosis Quirúrgica/efectos adversos , Fracturas Óseas/complicaciones , Estrechez Uretral/cirugía , Resultado del Tratamiento
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