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Background: Autologous tissues such as buccal mucosa (BM) are widely used for reconstruction of urethral strictures; however, limitations such as donor site morbidity and scarce tissue supply require the development of alternative biomaterials for urethral repair. The goals of this study were to determine the safety and efficacy of bi-layer silk fibroin (BLSF) matrices for urethral stricture repair and compare histological and functional outcomes to the standard approach, BM urethroplasty under good laboratory practices.Material and methods: A total of 13 rabbits exhibiting urethral stricture formation following electrocoagulation injury were treated with onlay urethroplasty with either acellular BLSF (N = 7) or autologous BM (N = 6) grafts for 3 months. Uninjured control rabbits were maintained in parallel (N = 4).Results and conclusion: Animals receiving BLSF implants were demonstrated to be functionally equivalent to BM grafts in their ability to restored strictured calibers, support micturition and promote tissue regeneration with minimal inflammation.

Introduction and objectivesSeveral factors influence recurrence after urethral stricture repair. The impact of socioeconomic factors on stricture recurrence after urethroplasty is poorly understood. This study aims to assess the impact that social deprivation, an area-level measure of disadvantage, has on urethral stricture recurrence after urethroplasty.MethodsWe performed a retrospective review of patients undergoing urethral reconstruction by surgeons participating in a collaborative research group. Home zip code was used to calculate Social Deprivation Indices (SDI; 0-100), which quantifies the level of disadvantage across several sociodemographic domains collected in the American Community Survey. Patients without zip code data were excluded from the analysis. The Cox Proportional Hazards model was used to study the association between SDI and the hazard of functional recurrence, adjusting for stricture characteristics as well as age and body mass index.ResultsMedian age was 46.0 years with a median follow up of 367 days for the 1452 men included in the study. Patients in the fourth SDI quartile (worst social deprivation) were more likely to be active smokers with traumatic and infectious strictures compared to the first SDI quartile. Patients in the fourth SDI quartile had 1.64 times the unadjusted hazard of functional stricture recurrence vs patients in the first SDI quartile (95% CI 1.04-2.59). Compared to anastomotic ± excision, substitution only repair had 1.90 times the unadjusted hazard of recurrence. The adjusted hazard of recurrence was 1.08 per 10-point increase in SDI (95% CI 1.01-1.15, P = .027).ConclusionsPatient social deprivation identifies those at higher risk for functional recurrence after anterior urethral stricture repair, offering an opportunity for preoperative counseling and postoperative surveillance. Addressing these social determinants of health can potentially improve outcomes in reconstructive surgery.

Purpose Materials and methods Results Conclusion The concept of interposing double dorsal preputial flaps to cover the urethroplasty was introduced in 2005 to reduce the risk of urethrocutaneous fistula (UCF). Our study aims to compare the postoperative outcomes of urethroplasty for distal hypospadias between two groups: one receiving single preputial flap coverage and another receiving double flap coverage.We conducted a retrospective analysis study of boys with primary distal hypospadias who underwent surgery by the same experienced surgeon, at our department between 2010 and 2021. The study population was divided into two groups: Group A, which underwent urethroplasty coverage with single dorsal preputial flap, and Group B, which underwent coverage with double flap. Postoperative complications were compared between the two groups.We collected 105 cases, comprising 51 in Group A and 54 cases in Group B. The mean age at surgery was 29 months in Group A and 24 months in Group B. Post‐operative follow‐up period ranged from 6 months to 8 years. Functional and cosmetic outcomes were judged excellent in 88.7%. Only 10 boys experienced complications requiring reoperation. UCF occurred in 5 patients from Group A, while no cases were reported in Group B (p = 0.024). Meatal stenosis was identified in three patients in Group A and in two patients in Group B (p = 1). No other complications, such as glans dehiscence or penile torsion, were noted.Double dorsal dartos flap is an effective method for covering the new urethra and can be recommended in the treatment of patients with virgin distal hypospadias. [ABSTRACT FROM AUTHOR]

Background: Snodgrass explained TIP (tubularized incised plate) for hypospadias repair in 1994 as a method to improve and widen mobilization of the urethral plate while performing Thiersch-Duplay urethroplasty. Since its introduction, various studies have reported describing the success of modified procedures for repairing distal hypospadias lesions. Aim: The present study aimed to assess the complications associated with Snodgrass urethroplasty (tubularized incised plate urethroplasty) in subjects presenting to the outpatient department. Methods: The study included 50 male subjects with fresh cases of anterior, middle, and distal hypospadias. All the subjects underwent the Snodgrass procedure for hypospadias management. Intraoperative and postoperative data were gathered and analyzed statistically. Results: No complication was encountered in 2% (n=1) subjects. Torsion and testicular ascent were seen in 2% (n=1) study subjects each. Urethral stricture and penile skin necrosis were seen in 6% (n=3) of subjects each. Meatal stenosis, urethrocutaneous fistula, and wound infection were seen in 10% (n=5) of study subjects each. Wound dehiscence was seen in 4% (n=2) of study subjects. Postoperative edema was seen in 30% (n=15) study subjects. Peri-catheter leak was recorded in 18% (n=9) of study subjects. Conclusions: The present study concludes that a properly nourished patient with good personal hygiene, optimum operative time with less intraoperative bleeding, adequate tissue for covering the neo urethra, and adequate mobilization of the graft are the bare necessities of a good surgical outcome. [ABSTRACT FROM AUTHOR]

To analyze current standards in urethroplasty by urologists employing buccal mucosal grafts (BMG) for treating urethral stricture disease (USD). An IRB-approved online survey was distributed to members of the Society of Genitourinary Reconstructive Surgeons (GURS) between July and October 2022 to assess BMG utilization in urethroplasty. Questions covered surgeon experience, graft harvest site, graft length, surgical technique, and perceived success rates. Of 350 invited GURS members, 134 responded (38%). Sixty-nine percentage were GURS fellowship-trained, performing 10-30 urethroplasties annually. Ninety-five percentage harvested their own grafts, with 99% preferring buccal mucosa as the primary site. Buccal mucosa was favored over fasciocutaneous flap for penile urethroplasty, regardless of circumcision status (95% with, 84% without). For bulbar urethroplasty with BMG, dorsal graft placement was favored (66%) over ventral (34%). Most surgeons (90%) preferred multiple BMGs over combined graft/flap for panurethral strictures. When harvesting long grafts, 56% preferred using both cheeks. Anastomotic urethroplasty was preferred over buccal graft urethroplasty for short bulbomembranous stenosis post-radiotherapy (63% vs 37%). Surgeons reported a success rate of 80%-90% (53%). The expanded scope of reconstructive urology has led to increased use of BMG in diverse urethral reconstructions. Buccal grafts are now preferred for penile, bulbar, and panurethral strictures, demonstrating high perceived success rates in the reconstructive community. [ABSTRACT FROM AUTHOR]

Transurethral procedures such as direct vision internal urethrotomy and urethral dilation have been the traditional treatments for urethral strictures. However, transurethral procedures are associated with high recurrence rates, resulting in many uncured cases and prompting major international urological societies to recommend urethroplasty as the standard treatment owing to its high success rate. In contrast, many Japanese general urologists have little doubts about treating urethral strictures with transurethral treatment. Therefore, urethral stricture treatments in Japan are not in line with those used in other countries. To address this, the Trauma, Emergency Medicine, and Reconstruction Subcommittee of the Japanese Urological Association has developed guidelines to offer standardized treatment protocols for urethral stricture, based on international evidence and tailored to Japan's medical landscape. These guidelines target patients with a clinically suspected urethral stricture and are intended for urologists and general practitioners involved in its diagnosis and treatment. Following the Minds Clinical Practice Guideline Development Manual 2020, the committee identified eight critical clinical issues and formulated eight clinical questions using the "patient, intervention, comparison, and outcome" format. A comprehensive literature search was conducted. For six clinical questions addressed by the existing guidelines or systematic reviews, the level of evidence was determined by qualitative systematic reviews. Quantitative systematic reviews and meta‐analyses were performed for the two unique clinical questions. The recommendation grades were determined using the Delphi method and consensus by the committee. These guidelines will be useful to clinicians in daily practice, especially those involved in the care of urethral strictures. [ABSTRACT FROM AUTHOR]

Background: Among pediatric surgical procedures, hypospadias surgery is one of the most difficult. The most prevalent complication following hypospadias repair is urethrocutaneous fistula. Numerous procedures have been developed to prevent and resolve this issue. One such method is platelet-rich fibrin (PRF) membrane preparation, which is a straightforward process requiring only the patient's serum. It has already been utilized successfully in plastic and reconstructive surgeries, where it significantly enhances the healing capacity and decreases the risk of infections. The purpose of this study is to assess the efficacy of an autologous PRF membrane in promoting healing and reducing fistula occurrence in cases of de novo distal hypospadias. Methods: Forty patients with primary distal hypospadias underwent TIP repair, as a part of a prospective controlled randomized study from April 2017 to February 2018. The cases were randomly allocated into two categories. TIP repair done in all cases by the same surgeon. Twenty cases comprised group A, which utilized a preputial or local dartos flap as an additional protective layer over the urethroplasty. In contrast, group B comprised 20 cases in which the urethroplasty was covered with a PRF membrane. The initial follow-up duration was 6 months. Each group's fistula incidence and other associated complications were documented. Results: Two groups were compared during the initial 6-month follow-up period. There were seven cases of urethrocutaneous fistula in group A, representing a 35% incidence rate. In group B, there were two cases that had fistula with an incidence of 10% in the early postoperative period. Two patients (10%) in group A developed meatal stenosis and only one patient in group B (5%) developed meatal stenosis. Glandular dehiscence occurred in one patient (5%) in group B. There was no skin wound infection in both groups. Conclusion: The PRF membrane may be a promising method as a coverage layer over the urethroplasty aiming to reduce the fistula rate after the repair. A larger comparative study is needed to evaluate the efficacy of PRF membranes in promoting wound healing. [ABSTRACT FROM AUTHOR]

To assess changes in the urinary microbiota after buccal urethroplasty. At the University of California San Francisco, we enrolled 9 adult males with urethral strictures undergoing buccal urethroplasty where we collected urine and oral swabs intraoperatively and 3 months postoperatively. 16S rRNA sequencing was used to profile the microbiota. At baseline, the mouth contains twice the number of unique bacteria (alpha diversity) and the microbial community is significantly distinct compared to the urinary tract. Despite having a buccal mucosa in the urinary tract after urethroplasty, the number of unique bacteria in the urine remained stable. However, the bacterial community composition and structure significantly changed in the urinary tract with the enrichment of Corynebacterium genus at 3 months post-urethroplasty procedure. In this pilot study, we showed that the alpha diversity in the urinary microbiota did not significantly change despite having a buccal tissue with the capacity to support high bacterial diversity in the urinary tract. To our surprise, the post-urethroplasty urinary microbiota was not a hybrid of baseline oral and urine microbiotas; the changes detected, such as an enrichment of the Corynebacterium genus, were more nuanced yet could profoundly impact surgical outcomes like graft changes and stricture recurrence. Our study not only established the feasibility but also outlined a blueprint for conducting a large-scale study to assess alterations in the urinary microbiome in relation to surgical outcomes. [ABSTRACT FROM AUTHOR]

To compare outcomes among patients undergoing first-time urethroplasty with buccal mucosa graft (BMG) who receive postoperative antibiotics vs those who do not. A retrospective cohort study was conducted using the TriNetX claims database between 2008-2022. Using CPT, ICD10, and LOINC codes, patients >18 years old undergoing primary urethroplasty with BMG who received an outpatient prescription for antibiotics between postoperative day 0-30 or did not were queried. Patients with positive preoperative urine culture or urinary tract infection (UTI) within 30 days preoperatively were excluded. Surgical outcomes included 5-year revision rates and revision-free survival. Safety outcomes included new UTI within 30 days, surgical site infection within 90 days, or Clostridium difficile infection within 30 days of urethroplasty. We identified 884 patients (81% antibiotic cohort, 19% nonantibiotic cohort) that met inclusion criteria. Age at time of urethroplasty, suprapubic tube presence, and pre-existing medical comorbidities were comparable between cohorts (Table 1A). There was no difference in 5-year rates and revision-free survival for endoscopic revision (11.5% vs 9.5%, relative risk (RR) 1.2, 95% CI [0.7, 2.0], recurrence-free survival (RFS) log-rank P =.6), re-do urethroplasty (12.9% vs 13.7%, RR 0.9, 95% CI [0.6, 1.5], RFS log-rank P =.7), or all-cause revision (19.8% vs 17.7%, RR 1.1, 95% CI [0.8, 1.6], P =.5) between groups. Postoperative rates of UTI, surgical site infection, and C difficile infection were similar between groups. In this large retrospective cohort study of patients undergoing urethroplasty with BMG, we observed no significant benefit from use of postoperative antibiotics on long-term revision rates or perioperative infectious complications. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to evaluate whether prolonged stenting reduces the risk of urethral stricture after proximal hypospadias (PH) with severe curvature (SC) repair. Materials and Methods We prospectively studied a cohort of patients with PH with SC repair who underwent urethral plate transection and urethroplasty between January 2010 and December 2020. According to the duration of stenting, the patients were divided into 2-, 4-, and 6-week groups. Postoperative complications and time of urethral stricture occurrence were analyzed. Results In total, 665 patients were included in the analysis. The overall incidence of complications was 26.6% (n = 177), including 42 cases of urethral strictures: 27 (64.3%) cases of urethral stricture occurred between 4 and 6 weeks after urethroplasty, 7 cases occurred between 7 weeks and 6 months after urethroplasty, 7 cases occurred more than 6 months after urethroplasty, and 1 case occurred at 3 weeks after urethroplasty. The incidence of urethral stricture in the 6-week group (1.8%) was significantly lower than that in the 4- (5.8%) and 2-week groups (10.9%) (p < 0.05). Conclusion Prolonged stenting reduces the risk of urethral stricture in PH with SC repair. Four to six weeks after PH with SC repair may be the key period for the formation of early urethral strictures. [ABSTRACT FROM AUTHOR]

The most prevalent complication in hypospadias repair is fistula formation. Adhering to the principle of providing urethroplasty coverage to mitigate fistula occurrence, we implemented a modification by integrating a spongiosum layer between the urethroplasty and the dartos flap. Our hypothesis posited that this approach would result in a reduced fistula formation rate. This study is a comparative analysis involving patients under 18 years of age who underwent primary hypospadias repair. The cases were allocated into two groups. In the study group, in addition to performing tubularized incised plate (TIP) repair, a spongiosum layer harvested from both sides of the urethra was used to cover the urethroplasty (modification of the Y-to-I urethroplasty). The control group underwent a standard TIP repair. The primary outcome was to assess urethrocutaneous fistula formation. Secondary outcomes included evaluating the development of meatal stenosis and glans dehiscence, along with assessing cosmetic results by the Hypospadias Objective Penile Evaluation (HOPE) score. Overall, 154 hypospadias cases were included in the study. Eighty-seven patients (56%) were allocated to the study group, and 67 (44%) were allocated to the control group. Urethrocutaneous fistula developed in 3 (3.4%) and 11 (16.4%) patients in the study and control group, respectively (p = 0.006). Glans dehiscence occurred in 2 (2.3%) patients in the study group and 4 (6%) patients in the control group (p = 0.198). Meatal stenosis was observed in 4 (4.6%) patients in the study group and 5 (7.5%) patients in the control (p = 0.452). The mean HOPE score was 59 in both groups (p = 0.36). This study details our encounters with the novel modification and compares the results with standard TIP. Our data suggest that adding a layer of spongiosum tissue over the urethroplasty reduces the complication of urethrocutaneous fistula without increasing the occurrence of dehiscence, significant meatal stenosis, or compromising cosmetic outcomes. We advocate for implementing the described surgical modification as a viable option for hypospadias repair. Summary table Complications observed among patients who underwent hypospadias repair. Summary table Complication Control: Standard TIP n = 67 Study: Additional layer n = 87 p -value Fistula 11 (16.4%) 3 (3.4%) 0.006 Meatal Stenosis 5 (7.5%) 4 (4.6%) 0.452 Dehiscence 4 (6%) 2 (2.3%) 0.198 [ABSTRACT FROM AUTHOR]

Over the years, Dorsal Inlay Graft (DIG) urethroplasty has gained worldwide acceptance for primary hypospadias repair. However, its safety and effectiveness for revision surgery are yet to be proven. The aim of the study is to assess and compare complication rates and functional outcomes of DIG surgery in revision versus primary hypospadias repair. We carried out a retrospective analysis of data collected from 53 consecutive DIG urethroplasties performed by a single surgeon at our institution. Patients were stratified in two groups – primary repair and redo-urethroplasty. For each group, we recorded standard pre-operative characteristics, surgical technicalities, complication rates and uroflowmetry parameters. Out of 53 DIG urethroplasties, 21 (39.6 %) where primary and 32 (60.4 %) were re-do. As expected, the two groups differed for median age at surgery: 20 months for primary and 68.5 months for revision surgery (p < 0.001). Additionally, all 21 (100 %) primary interventions were performed with a preputial graft, whereas among revision DIG urethroplasties only 2 (6.3 %) where preputial and 30 (93.8 %) were buccal (p < 0.001). Catheterization time (7 vs 8 days, p = 0.155) and postoperative complication rates (14.3 % vs 9.4 %, p = 0.581) were comparable between the primary and revision surgery group, respectively (all p >.05). Forty-two of the 53 patients underwent uroflowmetry during follow-up. Of these, 19 (63 %) patients presented with abnormal uroflowmetry and 11 (37 %) had equivocal parameters with no difference between the two groups. Dorsal Inlay Graft urethroplasty has long been known to be safe and effective for primary hypospadias repair. On the other hand, data on dorsal inlay graft urethroplasty as a salvage surgery after primary hypospadias repair failure is scarce. Surprisingly, according to our findings, surgical outcomes and complication rates are comparable between primary and revision hypospadias cases. Additionally, our results in the redo group are absolutely encouraging if compared to those reported in the literature for the same subset of patients. According to our findings, DIG urethroplasty is a safe and effective option to treat revision hypospadias repair. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion In narrow anterior urethral strictures, the combined buccal mucosa graft (BMG) with pedicled penile skin flap (PSF) represents a well‐known effective alternative to staged urethroplasty. We hypothesized that if the native urethral plate and adjacent corpus spongiosum were preserved, a narrower flap would be needed, and reinforced ventral stability could be achieved without compromising the surgical outcome.Twelve patients with narrow penile urethral strictures underwent single‐stage augmentation urethroplasty using a combined technique. A BMG was quilted to the corpora cavernosa in a dorsal onlay approach, and a longitudinal ventral PSF was transposed ventrally and sutured to the scarred native urethral mucosa on one side and to the BMG on the other side to form a neourethra of triangular form. The preserved corpus spongiosum was wrapped and fixed around the flap ventrally.The median age was 47 years (IQR 35–59), and the median stricture length was 5 cm (IQR 3, 8–7). The median surgical time was 205 min (IQR 172–236). The overall success rate (SR) was 91.7% without sacculation or diverticula formation after a median follow‐up period of 38 months (IQR 33–40). Three transient fistulas healed through prolonged urinary diversion. Five patients (41.7%) reported postvoid dribbling following urethroplasty.Preservation of the native urethral plate is a valuable adjunct to the combination of graft and flap for single‐stage augmentation urethroplasty for narrow urethral strictures, with satisfactory mid‐term success and an acceptable complication rate. [ABSTRACT FROM AUTHOR]

Background/aim: This study describes ventral-approach augmented nontransected anastomotic (vANTA) urethroplasty and presents the preliminary functional results of patients treated with this technique. Materials and methods: Twenty-three patients who underwent vANTA urethroplasty were included in the study. Stricture location, stricture length, preoperative uroflowmetry parameters (maximum flow rate (Qmax) and mean flow rate (Qmean)), preoperative International Index of Erectile Function (IIEF)-5 scores, operation time, postoperative complications, length of hospital stay, and follow-up periods were recorded. The Qmax, Qmean, and IIEF-5 scores of the patients were recorded again in the second and twelfth postoperative months. Preoperative and postoperative Qmax values and IIEF-5 scores were compared. Kaplan-Meier survival analysis was performed to demonstrate recurrence-free survival. Results: The mean age of the patients included in the study was 52.1 ± 16.9 years. Mean stricture length was 2.5 ± 0.5 cm. There was a statistically significant difference between preoperative and 2-month postoperative uroflowmetry Qmax values (6.9 (0.0-14.5) vs. 18.5 (5.5-41.5) mL/s; p < 0.001). There was no statistically significant difference in preoperative and 2-month postoperative IIEF-5 scores (p > 0.05). There was a statistically significant difference between preoperative and 1-year postoperative median Qmax values (7.2 (0.0-12.3) vs. 17.4 (11.2-24.3) mL/s; p = 0.001). There was no statistically significant difference between preoperative and 1-year postoperative IIEF-5 scores (p > 0.05). According to Kaplan-Meier recurrence-free survival analysis, the recurrence-free survival rate at 6 months was 95.7% Conclusion: In cases of bulbar urethral strictures, vANTA urethroplasty is an effective treatment option with limited postoperative complications. Preserving the underlying corpus spongiosum is important to avoid impaired sexual function. [ABSTRACT FROM AUTHOR]

Background: Hypospadias is considered the second most common congenital disorder in male offsprings worldwide after cryptorchidism, but the most common penile congenital malformation. Although usually successful, hypospadias surgery may result in a number of complications. The selection of suture material is an essential component of hypospadias correction, since it greatly influences the efficacy and longevity of the surgical result. Methods: The present observational comparative study was conducted in the Department of Pediatrics and General Surgery at SGRD Charitable Hospital, a tertiary care hospital, Amritsar, Punjab on 60 children ranging between >6 months to 5 years of age with clinical diagnosis of distal and mid penile hypospadias, who were divided into 2 groups - A and B - of 30 each and underwent Tubularized incised plate (TIP) urethroplasty with Vicryl and Polydiaxanone (PDS) suture, respectively during the period from January, 2023 to March, 2024. Data regarding the chief complaints, local examination, post-operative complications and urethral dilatation were recorded and findings were analyzed. Results: Out of the 60 cases, frequency of urethrocutaneous fistula (UCF) was significantly higher in Group A on post-operative day (POD) 10 (26.67%) and 15th day after discharge (16.67%), urethral stricture was an another significantly correlated post-operative outcome on 30th day after discharge (23.33%). There was significant difference in thinning of stream of urine after the removal of infant feeding tube (IFT) on POD 10 between Group A and Group B patients with p-value=0.038, denoting increased risk with the use of Vicryl 6-0 suture. Follow up urethral dilatation was required comparatively more in Group A patients (60%). Conclusions: PDS 6-0 suture is comparatively better in hypospadias repair as it is associated with fewer post-operative complications especially urethrocutaneous fistula which is commonest and most difficult to treat complication. PDS 6-0 suture reduced the prevalence of thin urinary stream and requirement of post-operative urethral dilatat [ABSTRACT FROM AUTHOR]

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Introduction. The use of oral mucosa in augmentation and replacement urethroplasty is the gold standard for several reasons. Most commonly, the mucous membrane of the cheek, the underside of the tongue or lip is employed. Assessing postoperative complications in the donor area is crucial as it impacts patients' quality of life.Objective. To evaluate early and late postoperative changes in the donor area after oral graft extraction for urethroplastyMaterials & methods. A retrospective analysis of the results of surgical treatment using oral mucosa from 2017 to 2022 was carried out. The study included 65 patients. The intensity of pain syndrome in the graft sampling area was assessed by patients on a visual analog scale (VAS). The donor area was sutured only in the case of tongue and lip mucosa sampling.Results. The mucous membrane of the oral cavity was harvested from different sites in 65 patients. Specifically, it was taken from the inside of the cheek in 49 patients (75.38%), from both inner sides of the cheeks in 13 (20.0%), the lower lip in two (3.07%) and the lower surface of the tongue in one (1.54%) patient, respectively. On the first day after surgery, the median pain level according to VAS was 4 points (range: 2 – 7), at the time of discharge — 3 points (1 – 6). After 120 days, a follow-up examination showed a regression of pain symptoms: the median was 0 points (0–1). In the late postoperative period, incomplete opening of the mouth was recorded in two patients (3.07%), cosmetic defect in the donor area in two (3.07%), discomfort during meals in six (9.23%), impaired sensitivity in the donor area in two (3.07%), exacerbation of chronic stomatitis and hypersalivation in two (3.07%) patients, respectively.Conclusion. The incidence of complications in the donor area is low, but for some patients this can result in a reduced quality of life. Using proper technique when extracting oral mucosa grafts reduces pain and the likelihood of early- and late-stage postoperative complications in this area.

Abstract 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.

Background: The optimal treatment for complex urethral stricture (CUS) is yet to be determined. Comparisons of methods based on validated questionnaires or objective outcome measures are lacking. Objective: To compare proximal urethrostomy and urethroplasty for CUS using objective measures and validated questionnaires, and to evaluate trends in subgroups of patients who underwent proximal urethrostomy as the intended definitive treatment versus first-stage urethroplasty. Design, setting, and participants: We identified all patients who underwent proximal urethrostomy at our center from 2004 to 2021. The control group comprised patients who underwent urethroplasty for CUS (strictures >6 cm, recurrent posturethroplasty strictures, or CUS due to lichen sclerosus or past hypospadias surgery). Outcome measurements and statistical analysis: The primary outcome was a recurrent stricture at a minimal follow-up of 1 yr. The secondary outcomes included validated questionnaires, uroflowmetry, and residual urine volume. Survival was compared by a Kaplan-Meier analysis. Results and limitations: The study included 57 proximal urethrostomy and 75 urethroplasty patients. Results for these two groups were as follows: the cumulative incidence of stricture recurrence over a median follow-up of 46 mo was 22.6% for proximal urethrostomy versus 36.2% for urethroplasty (p = 0.106); no statistically significant differences were observed between groups in terms of postoperative quality of urination or life, satisfaction with outcome, and erectile function. Both groups had a significant improvement in urinary flow after surgery (19.65 vs 20.29 ml/s), with no difference between the groups (p = 0.796); the proximal urethrostomy group had a significant improvement in postvoid residual after surgery, but there was no difference between the groups in the last follow-up visit (79.16 vs 52.03 ml; p = 0.245). A subgroup analysis of the proximal urethrostomy group showed no significant differences in cumulative primary or secondary outcomes. Limitations included the retrospective design and the relatively small study population. Conclusions: Comparisons of the two groups revealed no significant differences in stricture recurrence, results of validated questionnaires, or objective measures of urination. Patient summary: Proximal urethrostomy is equivalent to urethral reconstruction, and it should be offered as a viable solution for complex urethral stricture.

Objective: TIP is the most common preformed type of Urethroplasty. The intermediate barrier is used as a waterproofing layer to prevent fistula formation. Many tissues have been utilized as a barrier layer, with varying success rates. The search for a better intermediate layer will continue. In this study, we aim to evaluate the role of Buck's Fascia as a covering for the neo-urethra to prevent fistula formation in patients who underwent Snodgrass Urethroplasty. Methods: This prospective study was conducted between 2018 and 2022. Patients were randomly assigned to either Group 'A' or Group 'B'. Group A included patients who underwent the Snodgrass procedure with a Buck's Fascia cover, while Group B included patients whose neo-urethra was covered with the dartos flap. These patients were closely monitored for the development of short- and long-term complications in both groups, and the results were recorded. Results: The study involved 164 patients, who underwent midpenile and distal hypospadias repair using the Snodgrass technique. In Group 'A' (84 patients), the neo-urethra was covered with Buck's Fascia, while in Group 'B' (80 patients), the neo-urethra was covered with the dartos flap. The mean age of the children was (23.06 ± 16.12) months in group 'A' & (26.06 ± 14.07) months in group 'B'. mean operating time was (40 ± 11.43) minutes, in Group 'A', and (70 ± 17.43) minutes, in Group 'B'. Meatal stenosis occurred in 3.57% of children in Group 'A' and 10% of patients in Group 'B'. Urethral fistulas were encountered in 2.35% of cases in Group 'A'and 10% in Group 'B'. The difference between the groups was statistically significant. [ABSTRACT FROM AUTHOR]

Aim: To determine the relationship between preoperative nutritional status assessed using anthropometric measures and postoperative complications in pediatric surgical patients. Methodology: This prospective observational cohort study included 650 patients from 6 months to 18 years undergoing elective surgery at our institution. Elective surgery included procedures such as herniotomy, orchidopexy, urethroplasty, cystoscopy, PUV fulguration, pyeloplasty, ureteric reimplantation, stoma formation/closure, anorectoplasty, pull-through, choledochal cyst excision and repair, VP shunt insertion, lipomyelomeningocele repair, diastematomyelia excision and repair, and cyst excision. Nutritional status was standardized using Z scores for weight, length, and BMI. Patients were monitored for a month following surgery to detect any complications, and they were classified into five grades using the Clavien–Dindo classification. The duration of hospital stays and readmission within 30 days following discharge were secondary outcomes. Results: There were 627 patients of both sexes involved in the study: 350 patients aged 6 months to 5 years (Group A), while 277 were aged between 5 and 18 years (Group B). Wasting status was 47.71% in Group A and 41.52% in Group B. In Group A, 40% of patients were stunted, while 83.75% were in Group B. Group A had 57.14% underweight patients. The complication rate was 39.14% in Group A and 38.99% in Group B. The incidence of postoperative complications was not significantly different in malnourished patients. The patients with prolonged duration of surgery (> 2 h) developed more complications in both groups (Group A—67.2%, Group B—82.6%; p < 0.0001). In addition, the patients who experienced complications had lengthier hospital stays (p < 0.001 in both groups) and increased readmission rates (p = 0.016 in Group A and p = 0.008 in Group B). Conclusion: In our study, half of the patients in Group A and nearly two-third in Group B were malnourished. The preoperative poor nutritional status based on anthropometric parameters is not associated with increased postoperative complications. Randomized control trials linking preoperative malnutrition based on anthropometric measures and clinical outcomes in pediatric surgery patients are necessary to provide more robust information on this subject. [ABSTRACT FROM AUTHOR]

To determine urethral outcomes of single-stage metoidioplasty and radial forearm free flap (RFFF) phalloplasty using the labia minora ring flap for urethral lengthening (UL). A retrospective review was performed of patients undergoing single-stage metoidioplasty and RFFF phalloplasty utilizing the labia minora ring flap technique. The ring flap consists of endodermal labia minora tissue ventral to the clitoris and surrounding the vaginal introitus. During metoidioplasty, the ring flap accounts for the entirety of UL. During RFFF phalloplasty, the ring flap becomes the pars fixa (PF) urethra. The primary outcomes measured were rates of fistula, stricture, and surgical revision. Between November 2017 and August 2023, 311 patients underwent metoidioplasty or RFFF phalloplasty (mean follow-up 37 months). Of the 69 metoidioplasties, urethrocutaneous fistulas developed in 11 patients (16%); strictures occurred in 4 (6%). Of the 242 phalloplasty patients, there were 71 fistulas (29%), 56 of which resolved spontaneously. Strictures developed in 44 patients (18%). Twenty-five patients (10%) developed both a stricture and fistula. Surgical repair was required in 8/69 (12%) metoidioplasty patients and in 46/242 (19%) RFFF phalloplasty patients for an overall revision rate of 17%. UL during metoidioplasty or RFFF phalloplasty can be accomplished in a single stage using the labia minora ring flap with comparable surgical revision rates to previously described techniques. This approach can also be applied to other phalloplasty techniques. Many fistulas of the PF urethra resolve spontaneously. Higher urethral revision rates were seen in phalloplasty compared to metoidioplasty. [ABSTRACT FROM AUTHOR]

Aim: Megameatus intact prepuce (MIP) is a rare form of hypospadias. Different meatal/urethral advancement and urethroplasty techniques are used in the treatment of MIP. This study aimed to evaluate the success of various surgical methods for the treatment of MIP. Materials and Methods: Patients who underwent circumcision, meatoplasty, and urethroplasty techniques due to MIP between 2011 and 2022 were included in this study. Surgical success was accepted as the absence of complications and/or the need for additional treatment. The statistical significance level was accepted as 0.05. Results: This study included 100 patients with a median age of 33 months. Of these, 94 patients were admitted to our center with untreated MIP, 5 presented after circumcision and 1 after MIP repair in another center. The urethral stent placement rate was significantly lower in those patients with a glanular meatus location as in patients who underwent the meatoplasty technique (p<0.001). The complication rate was significantly higher in the Duplay with Posterior Meatal Incision (DPMI) technique when compared to the other techniques (p=0.033). There were no significant differences between the meatoplasty, Duplay urethroplasty, Pyramid urethroplasty, and DPMI techniques in terms of the need for additional surgical intervention (p=0.102). None of the five previously circumcised patients who underwent Duplay urethroplasty experienced any complications. When the complication rates were compared between the patient group presenting with untreated MIP and those who underwent Duplay urethroplasty, no statistically significant difference was detected (p=0.534). Conclusion: According to the conclusions of this MIP series, prior circumcision or the preference for any specific surgical technique that preserves the urethral plate did not affect the success of MIP treatment. [ABSTRACT FROM AUTHOR]

Objective Wound dehiscence after posterior sagittal anorectoplasty (PSARP) or anorectal vaginal urethroplasty (PSARVUP) for anorectal malformation (ARM) is a morbid complication. We present a novel anoplasty technique employing para-U-stitches along the anterior and posterior portions of the anoplasty, which helps buttress the midline U-stitch and evert the rectal mucosa. We hypothesized that, in addition to standardized pre- and postoperative protocols, this technique would lower rates of wound dehiscence. Materials and Methods A retrospective review of patievnts who underwent primary PSARP or PSARVUP with the para-U-stitch technique from 2015 to 2021 was performed. Wound dehiscence was defined as wound disruption requiring operative intervention within 30 days of the index operation. Superficial wound separations were excluded. Descriptive statistics were calculated. The final cohort included 232 patients. Results Rectoperineal fistula (28.9%) was the most common ARM subtype. PSARP was performed in 75% and PSARVUP in 25%. The majority were reconstructed with a stoma in place (63.4%). Wound dehiscence requiring operative intervention occurred in four patients, for an overall dehiscence rate of 1.7%. The dehiscence rate was lower in PSARPs compared with PSARVUPs (0.6 vs. 5.2%) and lower for reconstruction without a stoma compared with a stoma (1.2 vs. 2.0%). There were additional six patients (2.6%) with superficial wound infections managed conservatively. Conclusion We present the para-U-stitch anoplasty technique, which is an adjunct to the standard anoplasty during PSARP and PSARVUP. In conjunction with standardized pre- and postoperative protocols, this technique can help decrease rates of wound dehiscence in this patient population. [ABSTRACT FROM AUTHOR]

Purpose: There is a growing interest in reconstructive urology and female urethroplasty. We aimed to report our experience in ventral-onlay buccal mucosa graft (BMG) urethroplasty supported with Martius flap (MF) in treating female urethral stricture disease. Methods: We retrospectively evaluated data of 18 female patients (ages 35–78) who were diagnosed with urethral stricture disease and underwent ventral-onlay BMG urethroplasty supported with MF by single surgeon in a tertiary referral centre between February 2019 and October 2022. Detailed history, international prostate symptom score (IPSS), pelvic examination, urine flow rate (rate and pattern), post void residual (PVR), storage and voiding phase urodynamic study, and voiding cystourethrography were recorded. At the last visit; the number of urethral dilatations before urethroplasty, time from urethral dilation to urethroplasty, hospital stay, urethral catheterization time, postoperative IPSS, PVR and uroflowmetry values were recorded. Results: The presenting symptoms were obstructive voiding symptoms in 16 patients. While the mean number of urethral dilatation was 2.11 ± 1.93 (1–7), the mean time from dilatation to urethroplasty was 5.83 ± 5.00 (1–19 months) months. Maximum flow rate increased from 8.36 ± 3.26 ml/sec in preoperative uroflowmetry to 21.45 ± 5.27 ml/sec at the last follow-up (p < 0.001). Post-void residual urine (PVR) decreased from preoperative mean 116.66 ± 105.88 cc to 26.94 ± 22.69 cc postoperatively (p < 0.004). None of the patients developed stricture recurrence, incontinence or vaginal fistula until the last follow-up. The mean follow-up period was 17.28 ± 11.65 (1–35) months. Conclusions: A ventral-onlay BMG urethroplasty supported with MF represents an effective and reproducible treatment option for FUS in the present study. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of certain radiological parameters and patient characteristics in predicting the success of endoscopic treatment in ureteral stricture disease. Methods: Fifty one adult patients with ureteral stricture disease (< 1 cm) after developing due to upper ureteral stones with ureteroscopic laser disintegration were included and in addition to stone and patient parameters, radiological parameters including ureteral wall thickness (UWT) at the impacted stone site were also measured on computed tomography (CT) images. Patients were divided into two groups: Group 1: Patients with endoscopic treatment success and Group 2: Patients with endoscopic treatment failure. The possible relationship between the UWT values and other radiological parameter was comparatively evaluated. Results: Mean UWT value assessed at the treated stone site was significantly higher in cases unresponsive to endoscopic treatment with values of 2.77 ± 1.03 mm and 4.25 ± 1.32 mm in Group 1 and 2 respectively. A cut off value 3.55 mm for UWT was found to be highly predictive for endoscopic treatment failure. Conclusions: Our current results indicated that assessment of UWT value at the obstructing stone could be helpful enough to predict the likelihood of failure following endoscopic management of strictures with high sensitivity and specificity. Evaluation of this particular parameter could let the endourologists to look for more rational treatment alternatives with necessary measures taken on time. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Local estrogen therapy has been explored as an alternative to conventional testosterone therapy in children requiring urethroplasty for hypospadias. Our objective is to evaluate if preoperative estrogen stimulation reduces post-urethroplasty complications and enhances penile dimensions. A systematic search was conducted on various databases, selecting only randomized controlled trials (RCTs) that tested estrogen on hypospadias patients under 18 years. Articles underwent sorting following PRISMA guidelines and bias risk was assessed using the JBI clinical appraisal tool for RCTs. Out of 607 screened records, 10 underwent full-text review, and 4 randomized controlled trials (RCTs) were selected for analysis. The total patient cohort across studies was 387 with 174 in the estrogen group. All studies utilized topical estrogen, but in different formulations and timings. Prudence is necessary for interpreting results due to variations in formulation, timing, and hypospadias type across studies. Limited by a small number of studies and outcome presentation non-uniformity, the review suggests no change in penile dimensions or postoperative complications with topical estrogen. Further research is needed to explore wound-healing properties of estrogen in hypospadias through animal and human studies. Registration and protocol: Registered in Prospero CRD42024502183. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: To compare the outcomes of hypospadias repair using tubularized incised plate (TIP) urethroplasty and modified TIP with lateral skin to widen the urethral plate (WTIP). Materials and methods: Data were obtained from pre-pubertal boys who underwent primary hypospadias repair between May 2018 and July 2023. The cases were divided into two groups; one group underwent TIP with urethral plate ≥ 6 mm width and the other group with urethral plate width < 6 mm underwent WTIP. WTIP urethroplasty was performed by widening incisions on the outer margins of the urethral plate to incorporate penile and glandular skin lateral to the urethral plate to facilitate tubularization. Complication rates and urinary functions were compared. Results: A total of 157 patients were enrolled in this study. Eighty-eight cases with narrow urethral plate were subjected to WTIP urethroplasty, and the rest were subjected to TIP urethroplasty. The preoperative glans width in WTIP group was less than that in TIP group (P < 0.001), and 44.3% had midshaft meatus in WTIP group compared to 17.4% in TIP group (P < 0.001). However, the incidences of postoperative complications (17.6% vs. 21.6%, P = 0.550) were not statistically different between the TIP and WTIP groups. In addition, both groups did not differ significantly in postoperative uroflowmetry assessment. Conclusions: The described technique helps to create an adequately caliber aesthetic neomeatus and facilitates tubularization, especially in hypospadias with a narrow urethral plate. Our data suggest that augmentation of a narrow urethral plate with WTIP has a similar surgical outcome to that of the TIP procedure in patients with a wide urethral plate. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

To assess whether omitting routine post-operative imaging adversely impacts clinical outcomes after bulbar urethroplasty. Contrast imaging is commonly performed prior to catheter removal after urethroplasty but the clinical need for this is unclear. This was a matched, case-control analysis comparing patients undergoing routine voiding cystourethrogram (VCUG) prior to catheter removal after bulbar urethroplasty to patients without imaging. Patients were matched with respect to age, stricture etiology, length, and urethroplasty technique. Follow-up consisted of clinical assessment 3 weeks post-operatively for VCUG/catheter removal, cystoscopy at 3-4 months with clinical assessment annually. Outcome measures were 90-day complications (Clavien ≥2) and stricture recurrence (failure to pass a 16-Fr flexible cystoscope on follow-up). Chi-square and Kaplan-Meier analysis were conducted where appropriate. Hundred patients undergoing bulbar urethroplasty with VCUG prior to catheter removal were compared to 100 matched case controls without imaging. Groups did not differ with respect to failed endoscopic treatment (P =.82), prior urethroplasty (P =.09), comorbidities (P =.54), smoking (P =.42), or pre-operative bacteriuria (P = 1.00). The incidence of extravasation in the VCUG group was 2%. Overall 90-day complications were 9.5% and 15 patients developed recurrence with a median follow-up of 174 months. On chi-square analysis, 90-day complications did not differ between patients undergoing VCUG and those without (12% vs 7.0%; P =.34). On log-rank analysis, stricture recurrence did not differ between groups (P =.44). Routine imaging with VCUG after bulbar urethroplasty does not influence the risk of post-operative complications or stricture recurrence. Surgeons should consider avoiding this potentially unnecessary examination in routine clinical practice. [ABSTRACT FROM AUTHOR]

To implement a simplified, opioid-minimized, multimodal pain management (MPM) protocol and assess its effectiveness of reducing opioid dispersion while maintaining low postoperative complications, patient-reported pain, and patient-reported interference with quality of life (QOL) for men undergoing urethroplasty. Ninety-five men at a single academic center from October 2020 to October 2023 received a urethroplasty. We retrospectively reviewed the prior standard pain management (SPM) cohort before August 2021, then prospectively studied the MPM cohort after August 2021. For the SPM cohort, we collected postoperative day (POD) 1 pain scores from our Electronic Medical Record (EMR). For the MPM cohort, we obtained a validated pain and QOL assessment in the early postoperative period. The SPM cohort's POD 1 pain scores were compared with the MPM cohort's POD 2 pain scores. Opioid dispensation records were queried from the Prescription Monitoring Program. Seventy-five morphine milligram equivalent fewer opioids in the MPM cohort were prescribed than the SPM cohort (0 (interquartile range [IQR]: 0-0) vs 75 (IQR:0-150), P <.001, respectively). Patients with opioid discharge prescriptions fell from 50% in the SPM cohort to 11% in the MPM cohort (P <.001). Early postoperative pain scores remained low and showed no significant difference between the cohorts. Pain's interference with QOL measures remained low. Complications were rare across both cohorts. This simplified, multimodal analgesia protocol effectively decreases postoperative pain and opioid dispersion without affecting QOL outcomes after urethroplasty. This pain regimen can be easily adopted to decrease the use of postoperative opioids in men undergoing urethroplasty. [ABSTRACT FROM AUTHOR]

To evaluate the outcomes of ventral onlay buccal mucosal graft urethroplasty (VOBMGU) in bulbomembranous urethral strictures after transurethral resection of the prostate. After approval of the institutional ethical committee, we retrospectively examined the database of patients diagnosed with post-TURP urethral stricture (PTS) and treated by VOBMGU from January 2020 to January 2022. The patients were evaluated by retrograde urethrogram and voiding cystourethrogram. Follow-up evaluation included assessment of lower urinary tract symptoms, physical examination, uroflowmetry (Q-max and International Prostate Symptom Score) 3, 6, and 12 months of follow-up. A total of 30 patients underwent VOBMGU for bulbomembranous PTS were included. The median age of the patients was 63.5 (11.25). The median stricture length was 3.5 (1.5) cm. During follow-up, the mean Q-max significantly increased to 21.1 ± 5.5 mL/s (P <.0001), 20.1 ± 5.4 mL/s (P <.001), and 19.1 ± 5.3 mL/s (P <.003) at 3, 6, and 12 months, respectively. IPSS significantly decreased to 8.93 ± 6.37 at the 12-month follow-up mark (P <.0001). Three patients developed stricture recurrence and two patients developed postoperative urinary incontinence. VOBMGU in cases of bulbomembranous urethral PTS offered excellent functional outcomes with low stricture recurrence and minimal risk of incontinence. Further prospective studies are warranted to confirm the results. [ABSTRACT FROM AUTHOR]

To determine which bacteria are associated with an increased risk of 90-day complications after urethroplasty. Preoperative bacteriuria is associated with an increased risk of complications after urethroplasty. However, it remains unclear which specific micro-organisms are the primary drivers of this morbidity. A single-institution, 2-surgeon retrospective review was performed on patients undergoing urethroplasty from 08/2003 to 06/2021. Preoperative bacteriuria was considered significant when the patient had a mixed culture with ≥108 CFU/L or an identifiable micro-organism with ≥106 CFU/L. Descriptive statistics were used to summarize the results and chi-square was used to determine the association between 90-day complications (Clavien ≥2) and clinical characteristics/bacteria. Out of 1611 patients, 23.2% (373) had significant preoperative bacteriuria. The most common pathogens included coagulase-negative staphylococcus 18.5% (69), mixed growth 15.8% (59), Escherichia coli 10.7% (40), and Enterococcus 14.2% (53). 7.9% (128/1611) experienced a significant 90-day complication (Clavien-Dindo ≥2). Gram-negative bacilli including E coli, Pseudomonas sp, Klebsiella sp, Serratia sp, Citrobacter sp, Achromobacter sp, Stenotrophomonas sp, and Morganella sp were associated with higher rates of postoperative complications (14.2%; P =.01) as well as Enterococcus sp (15.1%; P =.03). However, gram-positive cocci (7.9%; P =.97), gram-positive bacilli (11.8%; P =.47), mixed growth (5.1%; P =.54) and Candida (16.7%; P =.27) were not. Neither escalating concentrations of bacteria (P =.44) or number of strains (P =.08) were associated with increased risk of complications. The main driver of bacteriuria-related complications after urethroplasty are gram-negative bacilli and Enterococcus sp. Patients with bacteriuria related to other micro-organisms can likely proceed with urethroplasty without increased risk of postoperative complications. [ABSTRACT FROM AUTHOR]

Hypospadias is a common congenital anomaly in males and frequently the patient undergoes multiple surgeries and may have complications. The treatment of severe "iatrogenic strictures" presenting in adulthood resulting from childhood hypospadias surgeries continues to be a challenge. The complexity of these cases is increased manifold due to the reasons of delayed presentation of many decades, varying lengths of the stricture, as well as poor healing capacity due to scarred territory from previous surgical attempts and associated complicating factors of renal failure and fistulae. In this paper, a case of reconstruction of a severe urethral stricture in a hypospadias cripple using a pedicled anterolateral thigh flap is reported. [ABSTRACT FROM AUTHOR]

Background: Tobacco is consumed mainly as smoking or smokeless tobacco [SLT]. "Smokeless tobacco" (SLT) term is used for the consumption of tobacco mixed with other constituents in form of chewing, spitting and dipping. Consumers of smokeless tobacco chew the products and spit out the juice that builds up in oral cavity which leads to various malignant and pre malignant lesions of oral cavity. Methods: Descriptive observational study was conducted in the city of Jodhpur through department of ENT, Head & Neck Surgery, Dr. SN medical college, Jodhpur. Results: Male to female ratio of smokeless tobacco usage was almost same. Increasing age was associated with occurrence of oral lesions and 43% patients developed oral lesions in the group > 64 yrs of age. Duration was another associating factor and 66% developed symptoms within < 10 years of usage. Oral submucous fibrosis is the most common lesion. Malignant lesions were seen in 0.3% cases. Around 78% cases developed dependency. Diabetic patients were seen more prone to development of oral lesions. Conclusions: Development of lesions in the oral cavity by smokeless tobacco depends on various factors such as quantity of tobacco usage per day, place of putting tobacco and duration. Awareness regarding its fatal effects and timely diagnosis and management can save many lives. [ABSTRACT FROM AUTHOR]

Background: Hypospadias is a wide-world congenital malformation that accounts for 1 of 300 live male births. Many procedures were considered for its management. As the tubularised incised plate (TIP) urethroplasty, the most prevalent technique, caused many complications, several modifications were applied to the original operation to improve the outcomes and alleviate complications. The aim of this study was to compare the outcome of the ordinary TIP urethroplasty with the technique modified without dissection of the glans penis. Materials and Methods: A total of 82 patients with a mean age of 18.8 (±14.8) months, were randomly assigned to undergo TIP with either complete glans wings mobilisation (Group A, n = 42 patients) or without glans dissection (Group B, n = 40 patients). To evaluate the effect of modified TIP urethroplasty without glanular dissection for treatment of distal hypospadias in contrast to classical TIP repair. Results: Both techniques showed similar outcomes regarding functional repair, with good to excellent results between 88% and 90% after 6 months of follow-up. Most confronted post-operative complications were wound infection, oedema, urethrocutaneous fistulas and meatal stenosis. Less frequently haematoma, post-operative bleeding and glans dehiscence were encountered. The differences in complication rates between the two studied groups were statistically insignificant except for oedema (P = 0.04), and need for urethral dilatation (P = 0.002) that were more prevalent among patients who were treated with classic TIP repair with complete glans wings mobilisation. Conclusion: From our point of view, it seems that TIP without glanular dissection technique does not outweigh TIP with complete glans wings mobilisation regarding functional outcomes and post-operative complications. [ABSTRACT FROM AUTHOR]

Mid-shaft/proximal (msp) and penoscrotal/scrotal/perineal (pssp) hypospadias treated by urethroplasty (UP) terminating at the corona (UPC) or UP terminating at the tip of the glans (UPG) were compared. UP performed at a single institute (n = 234) between 2003 and 2020 were grouped as: msp-UPC (n = 23), msp-UPG (n = 75), pssp-UPC (n = 81), and pssp-UPG (n = 55) to compare data obtained from medical records for post-UP complications (PUC; urethral stenosis, urethrocutaneous fistula, diverticulum formation, and bleeding; n = 234), post-UP uroflowmetry (PUF; average flow rate (Qave), maximum flow rate (Qmax), voiding time (VT), voided volume (VV) and urine flow curves) in 57 UP patients [msp-UPC (n = 5), msp-UPG (n = 12), pssp-UPC (n = 32), pssp-UPG (n = 8)] and 9 controls, and post-UPC esthetics (EST; n = 104). P < 0.05 was considered significant. Mean ages at UP (years) were: msp-UPC (3.1 ± 3.0), msp-UPG (3.3 ± 1.4), pssp-UPC (4.6 ± 2.4), and pssp-UPG (3.4 ± 1.4); p < 0.0001 by ANOVA test. Overall, there were significantly more PUC in pssp-UPG compared with pssp-UPC except for bleeding. Ages at PUF assessment were similar. Mean Qave (mL/s) for pssp-UPG (4.0 ± 1.0) was significantly less than pssp-UPC (5.9 ± 2.5; p < 0.05) and both were significantly less than controls (6.9 ± 1.8; p < 0.05, p < 0.01, respectively). Mean Qmax (mL/s) for pssp-UPC (11.4 ± 4.8) was significantly better than pssp-UPG (7.8 ± 2.3; p < 0.05) and for controls (14.9 ± 4.4) was significantly better than pssp-UPG (7.8 ± 2.3; p < 0.01). All VT (seconds) were similar to controls; all urine flow curves were normal. For EST in UPC (n = 104), 3 cases requested meatal advancement. UPC may be a valid option for treating pssp hypospadias because of significant differences in PUC/PUF and minimal EST issues compared with UPG. Prognosis Study Level-Ⅱ [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to retrospectively evaluate the etiology of urethral stricture disease (USD) in a large series of patients undergoing urethroplasty. Material and methods The multicenter retrospective cohort study was conducted at two reconstructive urology referral centers in years 2015–2022. Prior to the surgical intervention, all patients underwent diagnostic procedures including retrograde urethrography and voiding cystourethrography. We collected comprehensive demographic and medical data including the length and location of the stricture. We paid particular attention to identifying the underlying causes of USD in the medical records. Results The study included 949 patients meeting criteria, with a mean age of 53. The primary cause of USD was identified as iatrogenic (404 cases, 42.6%), followed by trauma (210, 22.1%), previous hypospadias repair (122, 12.9%), lichen sclerosus (32, 3.4%), and infections (12, 1.3%). Notably, 169 patients (17.8%) did not have a discernible cause for their USD and were thus classified as idiopathic. Furthermore, it was observed that 66% of idiopathic USD cases were localized in the bulbar urethra. The etiology of USD varied significantly based on its localization (p <0.01). The mean stricture length differed among different causes, with the longest in patients with USD due to lichen sclerosus (41 mm), followed by previous hypospadias repair (35 mm), and iatrogenic causes (29 mm), p <0.001. Conclusions Careful medical history-taking can identify the etiology of urethral stricture in over 80% of patients undergoing urethroplasty. The etiology of the USD impacts its location and length and thus can affect surgical treatment strategy and outcomes. [ABSTRACT FROM AUTHOR]

Introduction The aim of this study was to evaluate the outcomes of different urethroplasty procedures as well as two novel techniques, invented in our center, in management of urethral complications after total phallic reconstruction. Material and methods Different urethroplasty procedures were conducted according to the urethral pathology for 36 cis-male patients with urethral complications after total phallic reconstruction including meatoplasty, visual internal urethrotomy, staged Johanson urethroplasty utilizing either buccal mucosal graft or skin graft (Tiersche-Duplay principle), non-transecting urethroplasty (Hieneke-Miiklulicz principle), excision and primary anastomosis, as well as two novel techniques: urethral closure under a suprapubic tunnel and abdominal pedicled skin flap urethroplasty. Each patient was routinely evaluated one month after surgery and every 3 months for 12 months, with clinical evaluation, uroflowmetry and post-void residual urine. Results With a total of 41 procedures for the 36 patients, 32 patients (88.8 %) could eventually void while standing. The success rate was highest for staged Johanson urethroplasty using split thickness skin graft, staged abdominal pedicled skin flap and excision and primary anastomosis, respectively, while it was lowest for visual internal urethrotomy (0% success) and non-transecting anastomotic urethroplasty (50% success). For staged versus one-stage procedures prospective analysis, 17 out of 26 one-stage procedures (65.4%) succeeded while 13 out of 15 staged procedures (86.6%) succeeded. Conclusions Urethral complications following phalloplasty require complex procedures demanding a high level of surgical expertise. Abdominal pedicled skin flap urethroplasty is a viable option for long and recalcitrant urethral strictures. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review article will examine the current literature on hypospadias-related complications in adult patients. Recent Findings: In this article, we will review the most recent studies evaluating hypospadias-related stricture disease, erectile function, fertility, and psychosexual outcomes in adult men with history of hypospadias repair in childhood. Summary: Managing hypospadias-related complications in adult patients is challenging to reconstructive urologists due to the compounded complexity of innate tissue deficiency and history of prior surgical repairs. In this review, we explore overall functional outcomes of adults with history of hypospadias repair as well as repair strategies of hypospadias-related urethral stricture disease. We will review erectile function, fertility and psychosexual outcomes as well as potential complications, which often do not surface until late adolescence and adulthood. Although it is challenging to characterize and quantify hypospadias-related complications, further longitudinal study is needed to better care for this complex patient population. [ABSTRACT FROM AUTHOR]

Aisha Gabra,1 Badr Mohammed Beyari,2 Sara Jamal AlNuwaiser,2 Sarah Mamdouh Allaf,2 Reem Alghanmi,2 Rahaf Alrayiqi,2 Faisal Mosaad,1 Mazen Kurdi1 1Division of Pediatric Surgery, Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia; 2Faculty of Medicine and Surgery, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaCorrespondence: Aisha Gabra, Division of Pediatric Surgery, Department of Surgery, King Abdulaziz University Hospital, PO Box 80200, Jeddah, 21589, Saudi Arabia, Tel +966548545060, Email a.g_md@y7mail.comPurpose: This study aimed to report the outcomes of hypospadias repair performed at a tertiary-level hospital during 2018 to 2021.Methods: A retrospective chart review of 119 patients was performed.Results: The most frequent coronal hypospadias cases were distal. However, the most common scrotal hypospadias cases were proximal. The average age at the time of the first surgery was 2.4 years (standard deviation, ± 2.3 years). The tubularised incised plate technique was performed for 57 of these 119 patients. Urethral fistula was the most common complication associated with distal and proximal cases (23.96% and 30.43%, respectively). No significant correlation was observed between any complication and the surgical technique. Based on the logistic regression model, the duration of urethral stenting was statistically significant (p=0.025), indicating that a urinary catheter duration of more than 5 days resulted in a 2.9-times increased risk of postoperative urethral fistula.Conclusion: Prolonged urethral stenting for more than 5 days may result in subsequent urethral fistula development. Neither the severity of hypospadias nor the surgical technique seems to affect postoperative complications.Keywords: hypospadias, urethroplasty, tubularised incised plate

Abstract Background The European Association of Urology (EAU) defines primary urethral carcinoma (PUC) as a carcinoma that arises in the urethra without a previous diagnosis of carcinoma elsewhere in the urinary system. It is considered as a rare cancer, accounting for less than 1% of all malignant tumors and 5% of malignant tumors of the urinary system. The difficulty in diagnosis and its rarity can lead to delayed diagnosis and decreased survival. We think that a case report to be made in the literature for this rare disease with no consensus on treatment will contribute to disease management. Case presentation In this article, we describe the diagnosis and treatment process of a 75-year-old patient who was diagnosed with primary urethral cancer and had urethral discharge and difficulty in urination. The biopsy result from the suspected hyperemic area in the urethra in cystourethroscopy was primary urethral cancer. Urethrectomy followed by urethroplasty was performed on the patient's 2-cm primary urethral cancerous tissue. In the postoperative first month, an F-18 FDG whole-body PET scan for oncological evaluation showed increased pathological F-18 FDG uptake in the periphery of the mass in the penile urethra and indistinguishable boundaries from the prostatic urethra. After this, adjuvant gemcitabine and carboplatin therapy was planned by the oncology team. Conclusions Based on our outcome in this case, we believe that chemotherapy combined with surgery increases the chance of successful treatment in locally advanced urethral cancer.

Objective To investigate whether E. coli infection increases surgical site infection and postoperative fever in comparison with other pathogens. Methods A retrospective cohort study was conducted on 506 patients who underwent urethral segment resection and end anastomosis for the bulb or posterior urethral stenosis in our department during 2011 and 2019. According to occurrence of postoperative surgical site infection (SSI) or postoperative fever (POF), they were divided into SSI group (n=19) and non-SSI group (n=487), as well as POF group (n=61) and non-POF group (n=445 patients) respectively. Multivariate logistic regression analysis and LASSO algorithm were used to screen the potential risk factors. According to the results of positive preoperative urine culture in 302 patients, they were subsequently divided into E. coli infection group (n=80) and other pathogen infection group (n=222), and after reducing potential bias with propensity score matching, finally 48 patients were assigned into E. coli infection group, and 192 into other pathogen infection groups. The differences in occurrences of SSI and POF were compared between the above 2 groups of patients. Results Multivariate logistic regression analysis and LASSO algorithm revealed that positive preoperative urine culture was an independent risk factor for predicting SSI (P=0.012) and POF (P