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Christopher Gonzalez - One of the best experts on this subject based on the ideXlab platform.
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male Urethral Stricture american urological association guideline
The Journal of Urology, 2017Co-Authors: Hunter Wessells, Christopher Gonzalez, Sean P Elliott, Keith Rourke, Keith W Angermeier, Ron Kodama, Andrew C Peterson, James T Reston, John T Stoffel, Alex J VanniAbstract:Purpose: The purpose of this Guideline is to provide a clinical framework for the diagnosis and treatment of male Urethral Stricture.Materials and Methods: A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1990 to 12/1/2015) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of Urethral Stricture. The review yielded an evidence base of 250 articles after application of inclusion/exclusion criteria. These publications were used to create the Guideline statements. Evidence-based statements of Strong, Moderate, or Conditional Recommendation were developed based on benefits and risks/burdens to patients. Additional guidance is provided as Clinical Principles and Expert Opinion when insufficient evidence existed.Results: The Panel identified the most common scenarios seen in clinical practice related to the treatment of Urethral Strictures. Guideline statements were developed to aid the clinician in optimal evaluat...
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lichen sclerosus and isolated bulbar Urethral Stricture disease
The Journal of Urology, 2014Co-Authors: Joceline S Liu, Daniel Stein, Kelly Walker, Sanjiv Prabhu, Matthias D Hofer, Justin Han, Ximing J Yang, Christopher GonzalezAbstract:Purpose: Lichen sclerosus is a chronic inflammatory genital skin condition that can cause destructive Urethral scarring. To our knowledge no prior study has described lichen sclerosus in isolated bulbar Urethral Stricture segments without progressive disease originating from the penile urethra. We report the incidence of lichen sclerosus in isolated bulbar Urethral Stricture segments.Materials and Methods: We retrospectively reviewed the records of 70 patients after urethroplasty for isolated bulbar Stricture disease was performed from 2007 to 2013. Stricture specimens were re-reviewed by a single uropathologist. Cases were evaluated using common histological features of lichen sclerosus, including hyperkeratosis or epithelial atrophy, basal cell vacuolar degeneration, lichenoid lymphocytic infiltrate and superepithelial sclerosis.Results: Average patient age was 46.5 years (range 19 to 77) and average Stricture length was 3.5 cm (range 1 to 7). Of the patients 51 (73.0%) underwent excision and primary an...
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a geographic analysis of male Urethral Stricture aetiology and location
BJUI, 2013Co-Authors: Daniel Stein, Joseph D Thum, Ashish Pardeshi, Salvatore Sansalone, Sanjay Kulkarni, Guido Barbagli, Christopher GonzalezAbstract:What's known on the subject? and What does the study add? The incidence of specific aetiologies of Urethral Stricture disease has been reported from a variety of series throughout the world. Most reported Urethral Stricture series are from single institutions or from a specific region of the world. We provide a multi-centred series to compare aetiologic incidence between differing regional populations. Objective To better understand distinct regional patterns in Urethral Stricture aetiology and location among distinct regional populations. Patients and Methods Data on 2589 patients who underwent urethroplasty from 2000 to 2011 were collected retrospectively from three clinical sites, including 1646 patients from Italy, 715 from India and 228 from the USA. Data from all sites were single-surgeon series. As the data from the Italian and US cohorts were similar in aetiology, location and demographics, we combined these data to form group 1, and compared this group with men in the Indian cohort, group 2. Age, Stricture site and primary Stricture aetiology were identified for each patient. Stricture site and primary aetiology were determined by the treating surgeon. Primary aetiology was defined as iatrogenic, trauma including pelvic-fracture-related Urethral injury (PFUI), lichen sclerosus (LS), infectious, congenital, or unknown. Results There were more penile Strictures (27 vs 5%) and fewer posterior Urethral stenoses (9 vs 34%) in group 1. There were more iatrogenic Strictures identified in group 1 (35 vs 16%). When comparing the aetiology of iatrogenic Strictures alone, more Strictures in group 1 were attributable to failed hypospadias repair (49 vs 16%). More patients presented with LS (22 vs 7%) and external trauma (36 vs 16%) in group 2. Prevalence of Strictures of infectious aetiology was low (1%) with similar proportions between the two groups. Conclusions We have shown that significant regional differences in Stricture aetiology exist in a large multicentre cohort study. Group 1 had a higher proportion of penile Strictures, largely owing to more iatrogenic Strictures and, in particular, failed hypospadias repair. Group 2 had a higher proportion of PFUI and LS-associated urethal Stricture. Identified infection-related Urethral Stricture was rare in all cohorts. Significant regional differences in Stricture aetiology exist and should be considered when analysing international outcomes after urethroplasty. These data may also help the development of international disease prevention and treatment strategies.
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presenting symptoms of anterior Urethral Stricture disease a disease specific patient reported questionnaire to measure outcomes
The Journal of Urology, 2012Co-Authors: Geoffrey R Nuss, Michael A Granieri, Lee C Zhao, Dennis Joseph Thum, Christopher GonzalezAbstract:Purpose: We evaluated the spectrum of symptoms in men with Urethral Stricture presenting for urethroplasty.Materials and Methods: We identified 214 men who underwent anterior urethroplasty by a single surgeon (CMG) from March 2001 to June 2010. We retrospectively reviewed the initial patient history. All voiding and sexual dysfunction symptoms were recorded.Results: The most common presenting voiding complaints were weak stream in 49% of cases and incomplete emptying in 27%. Overall 21% of men did not present with voiding symptoms specifically addressed by the American Urological Association symptom index. The most common of these symptoms were spraying of urinary stream in 13% of men and dysuria in 10%. No symptoms were reported in 10% of men. Men with lichen sclerosus were more likely to present with obstructive symptoms (76% vs 55%) while men with penile Urethral Stricture were more likely to present with urinary stream spraying (17% vs 6%, each p <0.05). Sexual dysfunction was reported by 11% of men, ...
Bum Soo Kim - One of the best experts on this subject based on the ideXlab platform.
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Endourology/Urolithiasis Early Experience With a Thermo-Expandable Stent (Memokath) for the Management of Recurrent Urethral Stricture
2015Co-Authors: Hyun Su Jung, Hyun Tae Kim, Joon Woo Kim, Jun Nyung Lee, Eun Sang Yoo, Bum Soo KimAbstract:Purpose: To report our early experience with thermo-expandable Urethral stents (Memokath) for the management of recurrent Urethral Stricture and to assess the effi-cacy of Urethral stents. Materials and Methods: Between March 2012 and February 2013, 13 patients with re-current Urethral Stricture after several attempts with direct visual internal ure-throtomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy Urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation in-cluded uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis. Results: The mean patient age was 47.7 years (range, 18 to 74 years). The mean Urethral Stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile Urethral Strictures, respectively. The overall success rate was 69 % (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocuta-neous fistula induced by the stent and three patients with Urethral hyperplasia. The mean follow-up duration was 8.4 months. Conclusions: Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent Urethral Stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile Urethral Stricture can be factors predicting poor results
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nontransected ventral onlay augmented urethroplasty using autologous saphenous vein graft in a rabbit model of Urethral Stricture
Urology, 2014Co-Authors: Bum Soo Kim, Hyun Tae Kim, Se Yun Kwon, So Young Chun, Kyung Hee Choi, Min Park, Dae Hwan Kim, Phil Hyun Song, Tae Gyun KwonAbstract:Objective To evaluate the efficacy and feasibility of nontransected ventral onlay-augmented urethroplasty using an autologous saphenous vein graft in a rabbit model of Urethral Stricture. Methods Ten white male rabbits weighing 3.0-3.5 kg were selected, and a long tract Urethral Stricture was generated by excising an 0.8-cm wide and 2-cm long portion of the distal urethra. One month after the procedure, the rabbits were randomized into a Urethral Stricture group (n = 5) or urethroplasty with saphenous vein graft group (n = 5). Another 5 rabbits served as a normal control group. Retrograde urethrography was performed at 2, 4, 8, and 12 weeks after surgery in all groups, and the rabbits were killed at 12 weeks postoperatively for histopathologic and immunohistochemical evaluation. Results The mean operated Urethral width of the normal, Stricture, and vein graft group was 10.2 ± 0.84, 4.3 ± 0.97, and 10.04 ± 2.35 mm at 2 weeks postoperatively, respectively ( P = .008). The 4-, 8-, and 12-week postoperative urethrograms revealed results similar to those of the 2-week postoperative urethrograms. Histologic analysis showed the neourethra was epithelialized with urothelium in the vein graft group. All the rabbits survived throughout the study period without fistula formation or infection. Conclusion Nontransected ventral onlay-augmented urethroplasty using an autologous saphenous vein graft can be an effective and feasible procedure for the surgical management of long tract Urethral Stricture.
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early experience with a thermo expandable stent memokath for the management of recurrent Urethral Stricture
Korean Journal of Urology, 2013Co-Authors: Hyun Su Jung, Hyun Tae Kim, Joon Woo Kim, Jun Nyung Lee, Eun Sang Yoo, Bum Soo KimAbstract:PURPOSE To report our early experience with thermo-expandable Urethral stents (Memokath) for the management of recurrent Urethral Stricture and to assess the efficacy of Urethral stents. MATERIALS AND METHODS Between March 2012 and February 2013, 13 patients with recurrent Urethral Stricture after several attempts with direct visual internal urethrotomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy Urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation included uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis. RESULTS The mean patient age was 47.7 years (range, 18 to 74 years). The mean Urethral Stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile Urethral Strictures, respectively. The overall success rate was 69% (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocutaneous fistula induced by the stent and three patients with Urethral hyperplasia. The mean follow-up duration was 8.4 months. CONCLUSIONS Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent Urethral Stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile Urethral Stricture can be factors predicting poor results.
Hyun Tae Kim - One of the best experts on this subject based on the ideXlab platform.
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Endourology/Urolithiasis Early Experience With a Thermo-Expandable Stent (Memokath) for the Management of Recurrent Urethral Stricture
2015Co-Authors: Hyun Su Jung, Hyun Tae Kim, Joon Woo Kim, Jun Nyung Lee, Eun Sang Yoo, Bum Soo KimAbstract:Purpose: To report our early experience with thermo-expandable Urethral stents (Memokath) for the management of recurrent Urethral Stricture and to assess the effi-cacy of Urethral stents. Materials and Methods: Between March 2012 and February 2013, 13 patients with re-current Urethral Stricture after several attempts with direct visual internal ure-throtomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy Urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation in-cluded uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis. Results: The mean patient age was 47.7 years (range, 18 to 74 years). The mean Urethral Stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile Urethral Strictures, respectively. The overall success rate was 69 % (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocuta-neous fistula induced by the stent and three patients with Urethral hyperplasia. The mean follow-up duration was 8.4 months. Conclusions: Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent Urethral Stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile Urethral Stricture can be factors predicting poor results
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nontransected ventral onlay augmented urethroplasty using autologous saphenous vein graft in a rabbit model of Urethral Stricture
Urology, 2014Co-Authors: Bum Soo Kim, Hyun Tae Kim, Se Yun Kwon, So Young Chun, Kyung Hee Choi, Min Park, Dae Hwan Kim, Phil Hyun Song, Tae Gyun KwonAbstract:Objective To evaluate the efficacy and feasibility of nontransected ventral onlay-augmented urethroplasty using an autologous saphenous vein graft in a rabbit model of Urethral Stricture. Methods Ten white male rabbits weighing 3.0-3.5 kg were selected, and a long tract Urethral Stricture was generated by excising an 0.8-cm wide and 2-cm long portion of the distal urethra. One month after the procedure, the rabbits were randomized into a Urethral Stricture group (n = 5) or urethroplasty with saphenous vein graft group (n = 5). Another 5 rabbits served as a normal control group. Retrograde urethrography was performed at 2, 4, 8, and 12 weeks after surgery in all groups, and the rabbits were killed at 12 weeks postoperatively for histopathologic and immunohistochemical evaluation. Results The mean operated Urethral width of the normal, Stricture, and vein graft group was 10.2 ± 0.84, 4.3 ± 0.97, and 10.04 ± 2.35 mm at 2 weeks postoperatively, respectively ( P = .008). The 4-, 8-, and 12-week postoperative urethrograms revealed results similar to those of the 2-week postoperative urethrograms. Histologic analysis showed the neourethra was epithelialized with urothelium in the vein graft group. All the rabbits survived throughout the study period without fistula formation or infection. Conclusion Nontransected ventral onlay-augmented urethroplasty using an autologous saphenous vein graft can be an effective and feasible procedure for the surgical management of long tract Urethral Stricture.
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early experience with a thermo expandable stent memokath for the management of recurrent Urethral Stricture
Korean Journal of Urology, 2013Co-Authors: Hyun Su Jung, Hyun Tae Kim, Joon Woo Kim, Jun Nyung Lee, Eun Sang Yoo, Bum Soo KimAbstract:PURPOSE To report our early experience with thermo-expandable Urethral stents (Memokath) for the management of recurrent Urethral Stricture and to assess the efficacy of Urethral stents. MATERIALS AND METHODS Between March 2012 and February 2013, 13 patients with recurrent Urethral Stricture after several attempts with direct visual internal urethrotomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy Urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation included uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis. RESULTS The mean patient age was 47.7 years (range, 18 to 74 years). The mean Urethral Stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile Urethral Strictures, respectively. The overall success rate was 69% (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocutaneous fistula induced by the stent and three patients with Urethral hyperplasia. The mean follow-up duration was 8.4 months. CONCLUSIONS Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent Urethral Stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile Urethral Stricture can be factors predicting poor results.
Paul Rusilko - One of the best experts on this subject based on the ideXlab platform.
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prevalence and surgical management of concurrent adult acquired buried penis and Urethral Stricture disease
World Journal of Urology, 2019Co-Authors: Thomas W Fuller, Kelly Pekala, Katherine Theisen, Alexander D Tapper, Frank N Burks, Paul RusilkoAbstract:To describe the prevalence and surgical management of coexistent adult acquired buried penis (AABP) and Urethral Stricture disease. AABP patients often have urinary dribbling with resultant chronic local moisture, infection, and inflammation that combine to cause Urethral Stricture disease. To date, no screening or surgical management algorithms have been described. A multi-institutional retrospective study was conducted of the surgical management strategies for patients with concurrent AABP and Urethral Stricture disease from 2010 to 2017. AABP patient demographics, physical exam findings, and comorbidities were compared between those with and without Stricture disease to suggest those that would selectively benefit from screening for Stricture disease. Of the 42 patients surgically managed for AABP, 13 had Urethral Stricture disease (31.0%). Stricture location was universal in the anterior urethra. Sixty-one percent (n = 8) of Strictures were 6 cm or longer and managed prior to AABP repair with Kulkarni urethroplasty. Patients with Urethral Stricture disease were significantly more likely to have clinically diagnosed lichen sclerosus (p = 0.00019). There was no significant difference in BMI, age, or comorbidities between patients with and without Urethral Stricture disease. Extensive anterior Urethral Stricture is common in patients with AABP. Clinical characteristics cannot predict Stricture presence except possibly the presence of lichen sclerosus. Definitive Stricture surgical options include extensive Johanson Urethroplasty or Kulkarni Urethroplasty. Kulkarni Urethroplasty prior to AABP repair has the benefits of a single-stage repair, good cosmetic outcome with meatal voiding, and dorsal graft placement to allow safe degloving of the penis in the subsequent AABP repair.
Joceline S Liu - One of the best experts on this subject based on the ideXlab platform.
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lichen sclerosus and isolated bulbar Urethral Stricture disease
The Journal of Urology, 2014Co-Authors: Joceline S Liu, Daniel Stein, Kelly Walker, Sanjiv Prabhu, Matthias D Hofer, Justin Han, Ximing J Yang, Christopher GonzalezAbstract:Purpose: Lichen sclerosus is a chronic inflammatory genital skin condition that can cause destructive Urethral scarring. To our knowledge no prior study has described lichen sclerosus in isolated bulbar Urethral Stricture segments without progressive disease originating from the penile urethra. We report the incidence of lichen sclerosus in isolated bulbar Urethral Stricture segments.Materials and Methods: We retrospectively reviewed the records of 70 patients after urethroplasty for isolated bulbar Stricture disease was performed from 2007 to 2013. Stricture specimens were re-reviewed by a single uropathologist. Cases were evaluated using common histological features of lichen sclerosus, including hyperkeratosis or epithelial atrophy, basal cell vacuolar degeneration, lichenoid lymphocytic infiltrate and superepithelial sclerosis.Results: Average patient age was 46.5 years (range 19 to 77) and average Stricture length was 3.5 cm (range 1 to 7). Of the patients 51 (73.0%) underwent excision and primary an...
