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Purpose: To conduct a rigorous assessment of in-hospital morbidity after urethroplasty according with the European Association of Urology (EAU) guidelines for complication reporting., Methods: We retrospectively (2015-2019) identified 469 consecutive patients receiving urethroplasty (e.g. bulbar urethroplasty with grafts, penile urethroplasty with/without grafts/flaps, Johanson, de novo or revision perineostomy, end-to-end anastomosis, meatoplasty and/or meatotomy) at our tertiary care institution. Complications were graded with Clavien-Dindo score and Comprehensive Complication Index (CCI). Complications were classified in: bleeding no gastrointestinal, cardiac, gastrointestinal, genitourinary, infectious, neurological, oral, wound, miscellaneous, and pulmonary. Logistic regression tested for predictors of in-hospital complications and prolonged hospitalization (> 75th percentile). Kaplan-Meier and Cox regression investigated the effect of complications on failure after urethroplasty., Results: Overall, 161 (34.3%) patients experienced at least one complication. Of those, 47 (10%) experienced two or more complications and 59 (12.6%) experienced at least one Clavien-Dindo ≥ II complication. Only two patients had Clavien-Dindo III complications. Infectious was the most frequent complication, and de novo or revision perineostomy was associated with the highest rate of complications. The occurrence of any complications, as well as complication with Clavien-Dindo ≥ II were associated with prolonged hospitalizations, but not with higher rates of post-urethroplasty failure., Conclusions: Complications after urethroplasty were common events, but rarely with severe sequelae. Infectious were the most common complications and perineostomy was the type of urethroplasty with the highest rate of complications. The application of the EAU recommendations allowed the identifications of a higher number of complications after urethroplasty if compared with previous reports based on unsupervised chart review., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The surgical treatment of bulbar urethral strictures is still one of the most challenging reconstructive surgery problems. Bulbar urethral strictures are usually categorized as traumatic and non-traumatic strictures depending on the aetiology. The traumatic strictures are caused by trauma and they determine disruption of the urethra with obliteration of the urethral lumen, ending with fibrotic gaps between the urethral ends. Differently, the non-traumatic urethral strictures are mainly caused by catheterization, instrumentation, and infection, or they can also be idiopathic. They are usually asso-ciated with spongiofibrosis of the segment of the urethra that has been involved. Worldwide, two different surgical approaches are currently adopted for bulbar urethral repair: transecting techniques with end-to-end anastomosis and non-transecting techniques followed by grafting. Traumatic obliterated strictures require transection of the urethra allowing complete removal of the fibrotic tissue that involves the urethral ends. Conversely, non-traumatic, non-obliterated urethral strictures require augmentation of the urethral plate using oral mucosa grafts. Nowadays, it is still difficult to choose the correct surgical management for non-obliterated bulbar stricture repair. Indeed, different surgical techniques have been proposed (pedicled flap vs free graft, dorsal vs ventral placement of the graft, non-transecting technique using or non-using free graft, etc.) but none emerged as the best solution since all techniques have showed similar success and complication rates. Consequently, the final choice is still based on surgeon's preferences and patient's characteristics. Within the current manuscript, we like to present some of our tips and tricks that we developed along our prolonged surgical experience on the treatment of bulbar urethral strictures. These might be of interest for surgeons that approach this complex surgery. Moreover, our suggestions want to be useful regardless the type of chosen technique being adaptable for different scenario., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Objectives: To describe, step by step, a new one-stage dorsal skin flap urethroplasty for penile stricture repair., Materials and Methods: The surgery was accomplished through a midline incision on the ventral penile surface, the urethra was fully dissected from the corpora cavernosa and longitudinally opened along its dorsal surface. A penile skin island, based on the dartos fascia flap, was dissected and moved over the corpora cavernosa, and the urethra was moved and sutured over the penile skin flap., Results: Out of the 12 cases, 10 were classified successful and there were two failures. The operating time was 60 min. There was no postoperative fistula or urethral diverticulum., Conclusion: Our modified Orandi's technique was easy and feasible, and avoided fistula and diverticulum formation after repair., (© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.)

Objective: To evaluate the efficacy of the Memokath stent in managing recurrent bulbar urethral strictures., Materials and Methods: This is an investigative pilot stage 2A study in patients with a recurrent bulbar urethral stricture who underwent a Memokath stent implant from January 2014 to January 2016 in a single high-volume center for urethral reconstruction. The Memokath stent (Pnn Medical A/S, Kvistgaard, Denmark) was manufactured from nitinol, a biocompatible alloy of nickel and titanium, which was endoscopically placed. It had a 24-Fr outside diameter and was preloaded on a disposable delivery device. When correctly positioned, the stent was anchored by a warm water (55°C) instillation, which expanded the proximal end of the stent from 24 to 42 Fr .The stent was provided in lengths of 3-7 cm in 1-cm increments., Results: Sixteen patients were included in the study. The median follow-up was 16 months. In 7 patients (43.7%), the stent was removed within 1 year. The main adverse events were pain, encrustations, stones, and recurrent strictures. Four patients (25%) were considered a success and 12 (75%) were failures. Study limitations include the small sample., Conclusion: The Memokath stent was deemed to be not clinically helpful and had significant side effects, and therefore should not be considered a treatment option for men with bulbar urethral strictures., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The correlation between primary hypospadias repair and subsequent urethral strictures in adults has never been addressed., Objective: To evaluate the correlation between the site of primary hypospadias repair and the site of subsequent strictures and to investigate the predictive factors of failure after urethroplasty., Design, Setting, and Participants: An observational, retrospective, descriptive study of adult patients with urethral strictures following hypospadias surgery was carried out in a single centre., Intervention: Meatotomy, meatoplasty, end-to-end anastomosis, urethroplasty, perineostomy, urethrotomy, and fistula closure., Outcome Measurements and Statistical Analysis: We performed correlations between the site of primary hypospadias and the site of subsequent strictures, treatment failure, and patient lack of motivation for definitive treatment. Cross-tables, Kaplan-Meier curves, and logistic or Cox regression were used., Results and Limitations: A total of 408 patients, with median follow-up of 96 mo, were included. Concordance between the site of primary hypospadias repair and the site of subsequent strictures was observed. Multivariable analysis revealed that the number of previous operations needed for initial hypospadias repair was not associated with the risk of treatment failure (hazard ratio [HR] 0.96; 95% confidence Interval [CI] 0.88-1.04; p=0.3) or a lack of patient motivation (odds ratio 0.99, 95% CI 0.90-1.10; p=0.9). Length of stenosis (HR 1.38, 95% CI 1.11-1.71; p=0.004) and lichen sclerosus (HR 1.73, 95% CI 1.03-3.25; p=0.035) were associated with a higher risk of treatment failure. Our study is not representative of the entire population of patients with hypospadias repair., Conclusions: The stricture site is usually consistent with the site of hypospadias. Stricture length, but not the number of previous operations needed for primary hypospadias repair, was associated with the risk of failure., Patient Summary: The number of operations needed for hypospadias repair was not associated with failure of subsequent urethroplasty., (Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Urethral stricture is a disease characterized by a pathological narrowing of the urethra. Treatment for this condition often requires surgery using autologous grafts (urethroplasty). It is common practice to use patient’s own tissue like genital and extragenital skin, tunica vaginalis, buccal mucosa as a source of the graft. Alternative and safer approach is to use tissue-engineered graft created in a laboratory using patient’s autologous cells and biocompatible matrix (scaffold). The article presents the up-to-date achievements in lab-created tissue-engineered graft, describes all components needed to build a tissue-engineered structure of the graft for urethroplasty, and summarizes authors’ thoughts on advantages and disadvantages of various approaches to choose both cellular component and the matrix of future construction. The article reviews clinical studies conducted in the field of tissue engineering of the graft material for urethraplasty.

Background: Repair of penile urethral strictures is a challenging problem for which different techniques have been suggested., Objective: To describe a new surgical technique for one-stage penile urethroplasty using an oral graft and glue, and to assess its safety and efficacy., Design, Setting, and Participants: A retrospective review of medical records for patients who underwent one-stage penile urethroplasty using oral mucosa and glue from February 2013 to October 2014 was performed., Surgical Procedure: The penile urethra was opened and the urethral plate was incised to create a wide window within which the oral graft was pasted with glue. The urethra was sutured over the catheter., Outcome Measurements and Statistical Analysis: Clinical data were collected in a database. Intraoperative and postoperative complications and outcomes were assessed. A descriptive statistical analysis was performed., Results and Limitations: Fourteen patients were included in the study. Median operative time was 60min. The median postoperative stay was 3 d. Three intraoperative and one postoperative complication occurred. In all patients, voiding cystourethrography 2 wk after surgery failed to show urethral fistula or sacculation. No patients complained of penile chordee or sexual dysfunction after surgery. Median follow-up was 16 mo. Among the 14 patients, 12 (85.7%) procedures were successful and two (14.3%) were failures. Study limitations include the small sample size and short follow-up., Conclusions: An in vitro study and a one-stage reconstruction of penile urethral strictures with an oral mucosa graft and glue showed that the procedure is safe and efficient, but further studies including larger series of patients and longer follow-up are required., Patient Summary: We report on the repair of penile urethral stricture using one-stage urethroplasty with oral mucosa and glue. This new technique was safe and effective, with limited complications and satisfactory outcomes. We plan to increase the use of this technique in the future., (Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

A broad range of pathologic conditions of the ureter (strictures, obliterations, fistulas, and so on) requiring reconstructive plastic surgery is a challenging urological problem. A variety of approaches to solve the problem indicates the need of searching for new opportunities. A new direction in reconstructive surgery of the ureter is the tissue engineering. Tissue engineering involves the usage of matrices and cells. The matrices can be used both with cultured cells, and without them. This review represents the results of preclinical studies on feasibility of tissue engineering using as a matrix both natural and synthetic materials for different ureter impairments. Presently, there are no data on the use of tissue-engineering for the ureter reconstruction in clinical trials (i.e. involving human subjects). The results of studies presented in the review inspire certain optimism, but ureteral tissue-engineering is a difficult task requiring a balanced approach and well-thought-out design of preclinical studies.