Search

PurposeWe describe the lived experience of adults with acquired buried penis (AABP) through thematic analysis of patient interviews. We examine the challenges that patients face and the impacts of surgery.Materials and methodsThis mixed-methods study utilized validated instruments and semi-structured interviews to capture pre- and postsurgical outcomes. Semi-structured interviews were conducted with open-ended questions to elicit the impact of AABP on a patient's quality of life in several domains including urinary function, sexual function, interpersonal relationships and mental health. Recruitment was completed once we achieved thematic saturation.ResultsTwenty patients participated in the study; 11 underwent surgical treatment for AABP. Semi-structured interviewee responses were coded into 12 different themes and 39 subthemes. The most common themes were problems with urinary (19/20, 95%) and sexual function (19/20, 95%). Most participants (16/20, 80%) reported negative impacts of AABP on social life. Interviewees struggled with relationships (8/20, 40%) and mental health (11/20, 55%), often avoiding romantic relationships and reporting fear of rejection with concomitant depression and/or anxiety. The majority (70%, 14/20) experienced difficulties accessing care. Among patients who underwent surgery, the majority discussed improvement in urinary and sexual function (82% [9/11] and 73% [8/11], respectively). Though weight gain was a precipitating factor, weight loss did not result in symptom improvement. Rather, in 4/20 (20%), weight loss made their condition worse.ConclusionsPatients living with AABP experience profound negative impacts on quality of life including their urinary and sexual function, social life and mental health. Many patients face issues with access to care.

INTRODUCTION AND OBJECTIVE:There is a paucity of evidence documenting the lived experience of patients with adult acquired buried penis (AABP) and how this condition is affected by surgical treatme...

INTRODUCTION AND OBJECTIVE:Anterior urethral stricture disease (aUSD) is often a diagnosis of exclusion in men presenting with refractory lower urinary tract symptoms (LUTS). When the stricture is ...

INTRODUCTION AND OBJECTIVE:The LSE anterior urethral stricture classification system has previously been validated for its interrater reliability and ability to predict urethroplasty technique. Her...

INTRODUCTION AND OBJECTIVE:Identifying non-invasive biomarkers that distinguish Lichen Sclerosus (LS) induced from non-LS induced urethral strictures would have broad implications for the diagnosis...

INTRODUCTION AND OBJECTIVE:A successful urethroplasty has been defined in many ways. This variability poses a challenge when trying to compare success rates and techniques across studies. We aim to...

INTRODUCTION AND OBJECTIVE:Lichen sclerosus (LS) is a chronic inflammatory condition that can affect both the penile skin and urethral epithelium in men. Over time, severe impairment of sexual and ...

INTRODUCTION AND OBJECTIVE:Prior work has established that post-operative urethroscopy may be an effective tool to predict re-operation within 1 year following urethroplasty. Here, we examine early...

PurposeWe report multi-institutional outcomes in patients who underwent urethroplasty with a rectal mucosa graft.Materials and methodsWe used the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) database to identify patients who underwent urethral reconstruction with transanal harvest of a rectal mucosa graft. We reviewed preoperative demographics, stricture etiology, previous management and patient outcomes.ResultsWe identified 13 patients from April 2013 to June 2017. Median age at surgery was 54 years. The stricture etiology was lichen sclerosus in 6 of 13 patients (46%), idiopathic in 2 (15%), hypospadias in 1 (7%), prior gender confirming surgery in 3 (23%) and rectourethral fistula after radiation for prostate cancer in 1 (7%). Prior procedures included failed urethroplasty with a buccal mucosa graft in 9 of 13 patients (69%), direct vision internal urethrotomy in 2 (15%) and none in 2 (15%). Median stricture length was 13 cm. Stricture location in the 9 cisgender patients was panurethral in 5 (56%), bulbopendulous in 2 (22%) and bulbar in 2 (22%). It was located at the junction of the fixed urethra extending into the neophallus in all 3 patients (100%) who underwent prior gender confirming surgery. Mean rectal mucosa graft length for urethroplasty was 10.6 cm (range 3 to 16). Repair types included dorsal or ventral onlay, or 2-stage repair. Stricture recurred at a median followup of 13.5 months in 2 of 13 patients (15%). Postoperative complications included glans dehiscence, urethrocutaneous fistula and compartment syndrome in 1 patient each (7%). No rectal or bowel related complications were reported.ConclusionsUrethral reconstruction with a transanal harvested rectal mucosa graft is a safe technique when a buccal mucosa graft is unavailable or not indicated.

We evaluated the pathophysiology of lichen sclerosus and nonlichen sclerosus urethral stricture disease by comparing protein expression related to inflammation, cell cycle disruption, oxidative stress, hormone receptor status and infection.Tissue samples were collected from the urethral strictures of 81 patients undergoing urethroplasty. Clinical and demographic data were obtained by chart review. After identifying areas pathognomonic for lichen sclerosus a tissue microarray was created with cores from each sample and immunohistochemistry was performed.Patients had similar baseline demographics and comorbidities. Of the 81 strictures 58 were and 23 were not due to lichen sclerosus. Lichen sclerosus strictures were significantly longer and showed higher levels of inflammation. The proportion of T cells which stained positive for CD8 was significantly higher in strictures due to lichen sclerosus (50% vs 13%, p = 0.004). CCL-4 was expressed significantly more in strictures due to lichen sclerosus (76% vs 42%, p = 0.01). Several other inflammatory markers were only found in strictures due to lichen sclerosus. Block-like p16, a surrogate for high risk human papillomavirus infection, and varicella zoster virus were found only in lichen sclerosus urethral stricture disease samples, although both were rare. Epstein-Barr virus RNA was found in significantly more lichen sclerosus samples (37% vs 10%, p = 0.024).To our knowledge this is the first study to evaluate protein expression in lichen sclerosus urethral stricture disease. These strictures demonstrate increased inflammation compared to nonlichen sclerosus urethral strictures. Markers of oxidative stress, cell cycle dysregulation and the androgen receptor do not appear to be uniquely associated with lichen sclerosus urethral stricture disease. Positive staining for several viruses in samples of lichen sclerosus urethral stricture disease suggests a possible infectious etiology.

INTRODUCTION AND OBJECTIVE:The Urethral Stricture Symptom and Impact Measure (USSIM) is a condition-specific outcome measure for men with urethral stricture. Concept elicitation, cognitive, and pri...

INTRODUCTION AND OBJECTIVE:Oral mucosa graft urethroplasty was first described by the Ukrainian surgeon Kirill Sapezhko in 1894. His protege, I.A. Thyrmos, pioneered substitution urethroplasty with...

INTRODUCTION AND OBJECTIVE:Treatment considerations are unique for urethral stricture disease (USD) in patients requiring long-term clean intermittent catheterization (CIC). Patient characteristics...

INTRODUCTION AND OBJECTIVE:Post-void dribbling (PVD) and ejaculatory dysfunction (EjD) are common after urethroplasty (UP). Although the etiology remains unknown, they are thought to share a simila...

We evaluated the short and long-term surgical outcomes of urinary diversion done for urinary adverse events arising from prostate radiation therapy. We hypothesized that patient characteristics are associated with complications after urinary diversion.We performed a retrospective cohort study of 100 men who underwent urinary diversion (urinary conduit or continent catheterizable pouch) due to urinary adverse events after prostate radiotherapy from 2007 to 2016 from 9 academic centers in the United States. Outcome measurements included predictors of short and long-term complications, and readmission after urinary diversion of patients who had prostate cancer treated with radiotherapy. The data were summarized using descriptive statistics and univariate associations with complications were identified with logistic regression controlling for center.Mean patient age was 71 years and median time from radiotherapy to urinary diversion was 8 years. Overall 81 (81%) patients had combined modality therapy (radical prostatectomy plus radiotherapy or various combinations of radiotherapy). Grade 3a or greater Clavien-Dindo complications occurred in 31 (35%) men, including 4 deaths (4.5%). Normal weight men had more short-term complications compared to overweight (OR 4.9, 95% CI 1.3-23.1, p=0.02) and obese men (OR 6.3, 95% CI 1.6-31.1, p=0.009). Hospital readmission within 6 weeks of surgery occurred for 35 (38%) men. Surgery was needed to treat long-term complications after urinary diversion in 19 (22%) patients with a median followup of 16.3 months.Urinary diversion after prostate radiotherapy has a considerable short and long-term surgical complication rate. Urinary diversion most often cannot be avoided in these patients but appreciation of the risks allows for informed shared decision making between surgeons and patients.

INTRODUCTION AND OBJECTIVES:Urethroplasty has been associated with erectile dysfunction (ED), likely due to the close proximity of the cavernous neurovascular bundle to the membranous and bulbar ur...

INTRODUCTION AND OBJECTIVES:Perineal urethrostomy is a viable option for many complex urethral strictures; however, no comparison with anterior urethroplasty (AU) or complex AU regarding patient re...

INTRODUCTION AND OBJECTIVES:Endoscopic treatment of urethral stricture disease (USD) continues to be the most common treatment of USD despite its poor success compared to urethroplasty. AUA guideli...

Purpose: Subjective measures of success after urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior urethroplasty using objective measures as a proxy for success.Materials and Methods: Men 18 years old or older with urethral strictures undergoing urethroplasty were prospectively enrolled in a longitudinal, multi-institutional urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction.Results: At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurr...

Long segment urethral strictures with a compromised graft bed and poor vascular supply are unfit for standard repair and at high risk for recurrence. We assessed the success of urethral reconstruction in these patients with a ventral buccal mucosa graft and gracilis muscle flap.We retrospectively reviewed the records of 1,039 patients who underwent urethroplasty at Lahey Hospital and Medical Center between 1999 and 2014. We identified 20 patients who underwent urethroplasty with a ventral buccal mucosa graft and a gracilis muscle flap graft bed. Stricture recurrence was defined as the inability to pass a 16Fr cystoscope.Mean stricture length was 8.2 cm (range 3.5 to 15). Strictures were located in the posterior urethra with or without involvement of the bulbar urethra in 50% of cases, and in the bulbomembranous urethra in 35%, the bulbar urethra in 10% and the proximal pendulous urethra in 5%. Stricture etiology was radiation therapy in 45% of cases, followed by an idiopathic cause in 20%, trauma in 15%, prostatectomy in 10%, and hypospadias failure and transurethral surgery in 5% each. Nine patients (45%) were previously treated with urethroplasty and 3 (15%) previously underwent UroLume® stent placement. Urethral reconstruction was successful in 16 cases (80%) at a mean followup of 40 months. One of the patients in whom treatment failed had an ileal loop, 2 had a suprapubic tube and urethral dilatation had been done in 1. Mean time to recurrence was 10 months (range 2 to 17). Postoperatively 5 patients (25%) had incontinence requiring an artificial urinary sphincter.Urethroplasty for high risk, long segment urethral strictures can be successfully performed with a ventral buccal mucosa graft and a gracilis muscle flap, avoiding urinary diversion in most patients.

Purpose: Rectourethral fistulas are a rare but devastating complication of pelvic surgery and radiation. We review, analyze and describe the management and outcomes of nonradiated and radiation/ablation induced rectourethral fistulas during a consecutive 12-year period.Materials and Methods: We performed a retrospective review of patients undergoing rectourethral fistula repair between January 1, 1998 and December 31, 2009. Patient demographics as well as preoperative, operative and postoperative data were obtained. All rectourethral fistulas were repaired using an anterior transperineal approach with a muscle interposition flap and selective use of a buccal mucosal graft urethral patch onlay.Results: A total of 74 patients with rectourethral fistulas underwent repair with an anterior perineal approach and muscle interposition flap (68 gracilis muscle interposition flaps, 6 other muscle interposition flaps). We compared 35 nonradiated and 39 radiated/ablation induced rectourethral fistulas. Concurrent ure...

RESULTS: 76 TC cuffs were placed in 74 patients with mean age 74.3 years. Median cuff size was 4.5 cm. The cause of incontinence was secondary to prostate cancer (PC) treatment (96%), TURP (1.4%), pelvic tumor (1.4%) and pelvic trauma (1.4%). Prior pelvic radiation occurred in 34 (44.7%) patients. Previous surgery for stress urinary incontinence (SUI) occurred in 80.3% with either AUS (71.1%) or sling (9.2%). The mean number of prior SUI surgeries was 1.29 (04) and 36.8% had undergone 2 or more surgeries for SUI. There had been prior urethral violation with either erosion of prior device (32/74) or urethral injury (5/74) in 37 (48.7%) of cases. Twenty patients (26.3%) had undergone prior urethral reconstruction for refractory strictures. Overall complication rate at a mean follow up of 19.9 months (1.3-119) was 26.3%. The explantation rate was 14.5% at a mean of 14.2 (0.75-71) months. Revision was necessary in 9.2%. Overall and subgroup complication and continence rates are per Table 1. CONCLUSIONS: For men with sphincteric incontinence who have been radiated and/or had previous device erosion or urethral reconstruction, restoration of continence with TC AUS cuff placement is a useful salvage procedure. The complication rate is acceptable and reflects the complexity of this difficult patient population.

ative variables such as disease severity, blood loss, and length of hospital stay was dependent on severity of disease and patient comorbidities. No wound complications occurred at the STSG donor site. STSG take on the scrotum and penis ranged from 60-100%. Wound complications from local flap closure were clinically insignificant and includes small (2cm or less) areas of wound breakdown with no evidence of infection. CONCLUSIONS: Genital and perineal hidradenitis suppurativa is a debilitating and disfiguring disease. The use of radical resection and reconstruction with skin flaps and grafts provides a viable treatment option for these patients.