Overview of Urethral Reconstruction by Tissue Engineering: Current Strategies, Clinical Status and Future Direction
Zahra RashidbenamMohd Hafidzul JasmanPezhman HafezGuan Hee TanEng Hong GohXeng Inn FamChristopher C.K. HoZulkifli Md ZainuddinReynu RajanFatimah Mohd NorMohamad Aznan ShuhailiNik Ritza KosaiFarrah-Hani ImranMin Hwei Ng
35
Citation
78
Reference
10
Related Paper
Citation Trend
Aim: To compare the outcome of urethral stricture managed by different surgical techniques. Place and Duration: This Study was conducted at Lahore General Hospital, Lahore in the duration from May, 2022 to October, 2022. Methods: This randomized controlled trial was conducted on 60 patients divided equally in two groups. Both groups were assessed for maximum urinary flow 6 months after surgery, cause of the stricture, site of the stricture and success rate was assessed between both variables. T-test and Chi Square test with P < 0.05 as statistically significant were used to assess various outcomes between both groups. Results: The mean age in urethroplasty group was 44.43±10.618 years while in endoscopic urethrotomy group the mean age was 48.23±11.790. Urethroplasty was significantly successful in 80% patients whereas endoscopic urethrotomy was successful in 43.3% patients (P = 0.003). Conclusion: Urethroplasty is a safe and effective technique for treatment of urethral stricture. Keywords: Urethral stricture, Urethroplasty, Endoscopic urethrotomy, Efficacy
Urethrotomy
Cite
Citations (0)
Background: Urethral stricture is prevalent in all regions of the world with varying aetiological factors. Different surgical modalities have been employed in its management over the years. This study aimed to review etiologic factors, types, treatment modalities and outcomes of urethral stricture disease.Methodology: The medical records of patients who were managed for urethral stricture disease between 2006 and 2016 were reviewed. Data were extracted from patients' case files and operation records, which included the, demographics, aetiology, location, length, type of surgery for the urethral stricture and outcome data where available. The data obtained were analysed using statistical program for social sciences (SPSS) version 21.0Results: We retrieved the records of a total of 288 patients managed for urethral stricture within the study period. However, we analysed only 140 patients who had complete records. The mean age was 43.9 years. Most strictures were located in the bulbar urethral region (52.4%). Post-inflammatory strictures were the commonest, comprising of 36.6% of all cases. Anastomotic urethroplasty was found to be the most common form of surgical repair (44.0%). Buccal mucosal graft (BMG) urethroplasty was predominantly used for long segment strictures involving the bulbar urethra while penile skin flap urethroplasty was used for most strictures in the penile urethra or peno-bulbar urethra. Anastomotic urethroplasty had the best outcome. Conclusion: The findings of this study showed that post inflammatory urethral strictures remain the commonest types of stricture in our environment, consequently, it is imperative to develop public health strategies to reduce the incidence of sexually transmitted infections, which underlies the occurrence of these strictures. In terms of treatment, anastomotic urethroplasty was the commonest procedure, while BMG and penile skin flap urethroplasty were mostly employed for long segment strictures.
Etiology
Medical record
Cite
Citations (0)
Treatment of urethral strictures can be challenging, but, with appropriate preoperative evaluation and surgical planning it is possible to achieve successful results.To analyze if the stricture length affects the success with dorsal onlay buccal mucosal graft urethroplasty technique.Between January 2004 and June 2010 a total of 40 patients with anterior urethral stricture were treated with dorsal onlay buccal mucosal graft urethroplasty. Age, etiology of the stricture, stricture length (≤7 cm, and >7 cm), and localization of the stricture were assessed as the factors affecting success rate.The clinical outcome was defined as a failure when any operative instrumentation including dilatation was needed or the urine flow rate was less than 14 mL per second at the sixth month, postoperatively. The mean follow-up period was 43.44 months. Of 40 patients, 28 (70%) were successful and 12 (30%) were a failure. There was no statistically significant difference between the age groups, etiology of the stricture and success rate (p=0.26 and p=0.41). The statistical difference was significant for the localization and length of the stricture by means of success (p=0.002 and p=0.025).Our results show that the stricture length and localization are the most important variables for desirable success. Even though surgical techniques are constantly evolving, long strictures stay as a problem for urologists. Studies with larger number of patients with long urethral strictures may support our findings, and may prove the efficiency of these surgical techniques.
Buccal mucosa
Etiology
Cite
Citations (19)
Cite
Citations (0)
Urethral stricture disease is a common urological problem in men with increasing incidence and if left untreated it may result into various life threatening complications. The exact role of CT scan and MRI is yet to be defined. Majority of urologists consider urethroplasty as ‘gold standard’ treatment in the management of urethral stricture. However, to date the excision of diseased urethra and use of graft in urethroplasty has long-term success. The studies evaluating cost factors suggest that either an immediate urethroplasty or a single attempt at internal urethrotomy followed by urethroplasty is cost-effective. Obviously, the trend is toward treatment using reconstructive procedure which cures stricture disease without maintenance procedure e.g. dilation and repeat internal urethrotomy. EPA or augmented urethroplasty using buccal mucosa graft (BMG) are most commonly done procedures. American Urological Association (AUA) symptoms score and uroflometery (UFM) are more useful in the follow up of different urethroplasty. The application of tissue engineering methods has opened a new avenue in the treatment in urethral stricture with stem cells and secretomes awaiting transition from laboratory to clinical use.
Keywords: Urethra, LUTS, UTI, Spongiofibrosis, Stricture, Urethroplasty, Secretomes.
Urethrotomy
Cite
Citations (0)
Etiology
Reconstructive Surgery
Cite
Citations (13)
Buccal mucosa
Cite
Citations (16)
The recurrent course of the disease stricture is a complex problem for both the patient and the operating surgeon and requires an integrated approach to treatment only in expert centers.To assess the effectiveness of methods of surgical treatment of recurrent urethral strictures.At the University Clinic of Urology, Russian National Research Medical University named after N.I. Pirogov, an analysis of the results of surgical treatment of patients with recurrent urethral stricture from 2012 to 2020 was carried out. This work included patients who underwent surgical treatment for recurrent urethral stricture. A total of 120 men were involved in the work. The median length of the stricture was (min-max) - 2 (0.5-16 cm). In 95 (79.1%) patients, stricture of the bulbous urethra, in 15 (12.5%) - in the penile urethra, in 2 (1.7%) patients had panurethral stricture, in 6 (5.0%) - membranous urethra and in 2 (1.7%) - meatus. All patients were divided into two groups: with recurrent urethral stricture after primary DVIU (group I, n=77) and recurrent urethral stricture after primary urethroplasty (group II, n=43). Depending on the method of surgical treatment of recurrent urethral stricture, patients in group I were divided into 4 subgroups. Repeated DVIU + 3 months Autocatheterization - 16 (20.8%) patients; End-to-end urethroplasty - 37 (48.1%) patients; one-stage urethroplasty with a buccal graft or skin graft - 22 (28.6%) patients; multistage urethroplasty or perineostomy - 2 (2.5%) patients. Group II was also divided into 4 subgroups. DVIU - 17 (39.5%) patients; end-to-end urethroplasty - 6 (13.9%) patients; one-stage urethroplasty with a buccal graft or skin graft - 9 (20.9%) patients; multistage urethroplasty - 11 (16.7%) patients. Median Qmax - 4.68 ml/sec. Preoperative cystostomy was observed in 31 (25.8%) patients.The median follow-up was 24 months (range 12 to 76 months). Depending on the method of surgical treatment of recurrent urethral stricture, the effectiveness of DVIU according to strict indications was 75.7%. End-to-end urethroplasty showed an efficiency of -88,4%. One-stage augmentation urethroplasty had an efficiency of -77,4%, and multi-stage urethroplasty showed an efficiency of 84.6%. The IPSS value for the observation period 2 years was 2.6+/-0.9 points. The average value of Qmax at the time of observation was 19.4+/-7.1 ml/sec. The effectiveness of the treatment was 82%. During the follow-up period, a relapse was noted in 22 (18%) patients. The overall effectiveness of the treatment of recurrent urethral stricture, taking into account the treatment of recurrent cases of disease recurrence, was 97.5%.Urethroplasty is the treatment of choice for recurrent urethral strictures, which has been shown to be more effective than DVIU. However, the results of urethroplasty for recurrent strictures are worse than for primary strictures.
Cite
Citations (1)
Introduction. The urethroplasty of the urethral stricture disease is still a severe problem for surgeons. The aim of this study is to evaluate own results of buccal mucosa graft urethroplasty (BMGU) for the treatment of urethral stricture. Aim. Evaluation of own results of urethroplasty with a graft of the oral mucosa in the treatment of urethral strictures. Materials and methods. Between 01.08.2014 and 01.06.2020 we treated 136 patients with urethral stricture at our Medical Centers, where we provided buccal mucosa graft urethroplasty for bulbar and penile urethra. Results. The bulbar stricture was found among 105 patients of 136 (77,1 % cases), in which 64 had stricture in proximal part and 41 – in distal part of the urethra, 19 patients – in penile urethra and the other part had panurethral lesion. The median length of the stricture was measured as 3,8 ± 0,6 sm in the first three groups, and in the last group it was 10,4 ± 1,5 sm. At a median follow-up of 16,3 months 87,5% of patients in the first group, 90,2 % in the second, 84,2 % in the third and 83,3 % in the fourth group had no stricture recurrence and were satisfied with BMGU. Conclusion. For patients with urethral stricture disease, BMGU offers excellent success, morbidity with different techniques and methods, which statistically are equal to each other.
Buccal mucosa
Cite
Citations (0)
Introduction. Modern reconstructive and reconstructive surgery for treating urethral strictures in men has evolved significantly over the years with the addition of various advanced techniques. However, when it comes to treating urethral strictures caused by lichen planus, there is a need for a unified approach in selecting the appropriate buccal urethroplasty technique. Aim. The aim of this study is to evaluate the clinical efficacy of the modified buccal urethroplasty method in treating urethral stricture disease (ULD) caused by scleroatrophic lichen (SAL). Materials and Methods. A prospective comparative study was conducted, involving 50 patients who underwent different methods of surgical correction for urethral stricture disease between 2005 and 2021. The basic group (n=25) included patients who underwent modified buccal urethroplasty, while the comparison group (n=25) underwent conventional buccal urethroplasty. Results. The modified method of buccal urethroplasty resulted in a 1.8 times decrease in the incidence of complications, such as urethral stricture recurrences, incompetence of sutures, fistulas, urethral hair growth, and urethral sclerosing, when compared to the standard methods of surgery. Conclusion. The clinical effectiveness of the modified buccal urethroplasty method may be attributed to the rich vascular network of the buccal mucosa, which promotes good engraftment of the flap and its structural similarity to the urethral tissues. This study highlights the importance of selecting appropriate surgical techniques for treating urethral strictures caused by scleroatrophic lichen to improve clinical outcomes and decrease the incidence of complications.
Buccal mucosa
Cite
Citations (1)