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Benjamin N Breyer - One of the best experts on this subject based on the ideXlab platform.
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qualitative analysis of the content found in online discussion boards for urethral stricture disease and Urethroplasty
Urology, 2019Co-Authors: Benjamin Cedars, Andrew J Cohen, Kirkpatrick B Fergus, Nima Baradaran, Medina Ndoye, Puneet Kamal, Benjamin N BreyerAbstract:Abstract Objective To describe the patient experience and chief concerns with Urethroplasty to improve physician understanding and patient education. Online discussion boards allow patients with urethral stricture disease (USD) to connect with other USD patients. It is unknown how men use these web resources and what information is available about Urethroplasty. Methods Three online forums featuring Urethroplasty were identified by Google search. Thematic analysis categorized the content of posts using manually applied codes, with inter-rater reliability and descriptive statistics generated by Dedoose (Los Angeles, CA). Results A total of 140 unique posters contributed 553 posts to the forums. Posts were categorized as information support (n = 651), issues postUrethroplasty (n = 470), own experience preUrethroplasty (n = 336), feelings towards other posters (n = 312), what to expect postUrethroplasty (n = 265), feelings after Urethroplasty (n = 228), and considerations before Urethroplasty (n = 134). Experience navigating the healthcare system with USD (n = 141) and weak urine stream (n = 70) were the most frequent preUrethroplasty complaints. Postoperative pain (n = 164) was the most frequent issue. Patients expressed more positivity (n = 126) and satisfaction (n = 120) than negativity (n = 33) with Urethroplasty. Conclusion Patients participated in online discussions to share experiences with USD and Urethroplasty, receive emotional support, and find answers. Men were more often satisfied than not with their Urethroplasty outcomes, with 88% of postoperative feelings coded as positive or satisfied compared to negative. This study provides physicians with insight into the experiences of patients and how to best educate them.
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outcomes of Urethroplasty to treat urethral strictures arising from artificial urinary sphincter erosions and rates of subsequent device replacement
Urology, 2017Co-Authors: Sorena Keihani, Jill C Buckley, Keith O'rourke, Jason Chandrapal, Andrew C Peterson, Joshua A Broghammer, Nathan Chertack, Sean P Elliott, Nejd F Alsikafi, Benjamin N BreyerAbstract:Objective To evaluate the success of Urethroplasty for urethral strictures arising after erosion of an artificial urinary sphincter (AUS) and rates of subsequent AUS replacement. Patients and Methods From 2009-2016, we identified patients from the Trauma and Urologic Reconstruction Network of Surgeons and several other centers. We included patients with urethral strictures arising from AUS erosion undergoing Urethroplasty with or without subsequent AUS replacement. We retrospectively reviewed patient demographics, history, stricture characteristics, and outcomes. Variables in patients with and without complications after AUS replacement were compared using chi-square test, independent samples t test, and Mann-Whitney U test when appropriate. Results Thirty-one men were identified with the inclusion criteria. Radical prostatectomy was the etiology of incontinence in 87% of the patients, and 29% had radiation therapy. Anastomotic (28) and buccal graft substitution (3) Urethroplasty were performed. Follow-up cystoscopy was done in 28 patients (median 4.5 months, interquartile range [IQR]: 3-8) showing no urethral stricture recurrences. Median overall follow-up was 22.0 months (IQR: 15-38). In 27 men (87%), AUS was replaced at median of 6.0 months (IQR: 4-7) after Urethroplasty. In 25 patients with >3 months of follow-up after AUS replacement, urethral complications requiring AUS revision or removal occurred in 9 patients (36%) and included subcuff atrophy (3) and erosion (6). Mean length of stricture was higher in patients who developed a complication after Urethroplasty and AUS replacement (2.2 vs. 1.5 cm, P = .04). Conclusion In patients with urethral stricture after AUS erosion, Urethroplasty is successful. However, AUS replacement after Urethroplasty has a high erosion rate even in the short-term.
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The Impact of Age on Urethroplasty Success
Urology, 2017Co-Authors: Mya E. Levy, Kristian D. Stensland, Bryan B Voelzke, Bradley A Erickson, Benjamin N Breyer, Thomas G Smith, Alex J Vanni, Jeremy B. Myers, Christopher McclungAbstract:Objective To determine if age is an independent predictor of surgical success in patients undergoing Urethroplasty. Urethroplasty performed by excision and primary anastomosis depends on vascular collateralization. Successful augmented Urethroplasty depends on graft neovascularization. Older patients have more comorbid conditions including peripheral vascular disease associated with reduced penile blood flow. Methods This is a retrospective review of urethroplasties from 11 institutions. Primary outcome was functional success at 1 year from surgery, defined as freedom from post-Urethroplasty procedures. Secondary outcome was freedom from cystoscopic evidence of stricture recurrence at 3 months. Study outcomes were compared between 2 age cohorts ( Results Of 322 urethroplasties, 258 were performed in patients Conclusion Urethroplasty success may be affected by comorbidities but not age. Age alone should not be used as an absolute exclusion criterion for men needing urethral reconstruction.
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measuring and predicting patient dissatisfaction after anterior Urethroplasty using patient reported outcomes measures
The Journal of Urology, 2016Co-Authors: Laura A Bertrand, Christopher Mcclung, Bryan B Voelzke, Benjamin N Breyer, Alex J Vanni, Jeremy B. Myers, Sean P Elliott, Christopher A Tam, Gareth Warren, Bradley A EricksonAbstract:Purpose: Subjective measures of success after Urethroplasty have become increasingly valuable in postoperative monitoring. We examined patient reported satisfaction following anterior Urethroplasty using objective measures as a proxy for success.Materials and Methods: Men 18 years old or older with urethral strictures undergoing Urethroplasty were prospectively enrolled in a longitudinal, multi-institutional Urethroplasty outcomes database. Preoperative and postoperative assessment included questionnaires to assess lower urinary tract symptoms, pain, satisfaction and sexual health. Analyses controlling for stricture recurrence (defined as the inability to traverse the reconstructed urethra with a flexible cystoscope) were performed to determine independent predictors of dissatisfaction.Results: At a mean followup of 14 months we found a high 89.4% rate of overall postoperative satisfaction in 433 patients and a high 82.8% rate in those who would have chosen the operation again. Men with cystoscopic recurr...
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trends utilization and immediate perioperative complications of Urethroplasty in the united states data from the national inpatient sample 2000 2010
Urology, 2015Co-Authors: Sarah D Blaschko, Amjad Alwaal, Jack W Mcaninch, Catherine R Harris, Uwais B Zaid, Thomas W Gaither, Carissa Chu, Charles E Mcculloch, Benjamin N BreyerAbstract:Objective To determine national Urethroplasty trends based on type of surgery and patient and hospital characteristics. We hypothesized that the number of complex Urethroplasty procedures performed has increased over time and may be associated with increased periprocedure complications. Methods The National Inpatient Sample from years 2000 to 2010 was queried for patients with Urethroplasty-associated International Classification of Diseases, Ninth Revision, Clinical Modification codes. We analyzed trends in Urethroplasty procedures, patient demographics, comorbidities, and hospital characteristics. We evaluated the relationship between patient demographics and comorbid disease, length of hospital stay, hospital charges, and inpatient complications. Results During the study period, an estimated 13,700 men (95% confidence interval, 9507-17,894) underwent Urethroplasty nationally. Excision with primary anastomosis, buccal graft, and other graft or flap Urethroplasty comprised 80.3%, 14.3%, and 5.4%, respectively. Buccal mucosa graft procedures increased over time ( P = .03). Only 1.6% of hospitals have ≥20 urethroplasties performed annually. Urethroplasty type and Urethroplasty volume were not associated with immediate complication rates. Hypertension, diabetes, chronic pulmonary disease, and obesity were the most common comorbidities in Urethroplasty patients. Complications during Urethroplasty hospitalization occurred in 6.6% of men, with surgical or wound complications being the most common (5.2%). Postoperative mortality was exceedingly rare. Older patients, African Americans, and patients with increased comorbidities were more likely to have complications. Conclusion An increasing number of buccal mucosa graft urethroplasties occurred over time. Urethroplasty patients have low immediate perioperative morbidity (6.6%) and mortality (0.07%). Patients who are older, African American, or have more comorbid conditions have greater risk for complications.
Hemant R Pathak - One of the best experts on this subject based on the ideXlab platform.
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impact of prior urethral manipulation on outcome of anastomotic Urethroplasty for post traumatic urethral stricture
Urology, 2010Co-Authors: Bhupendra P Singh, Mukund G Andankar, Sanjaya K Swain, Vimal Dassi, Harish K Kaswan, Vipul Agrawal, Hemant R PathakAbstract:Objective To determine the impact of earlier urethral interventions on the outcomes of anastomotic Urethroplasty in post-traumatic stricture urethra. Methods From October 1995 to March 2008, a total of 58 patients with post-traumatic posterior urethral stricture underwent anastomotic Urethroplasty. Eighteen patients had earlier undergone urethral intervention in the form of urethrotomy (3), endoscopic realignment (7), or open Urethroplasty (8). Success was defined as no obstructive urinary symptoms, maximum urine flow rate ≥ 15 mL/s, normal urethral imaging and/or urethroscopy, and no need of any intervention in the follow-up period. Patients who met the above objective criteria after needing 1 urethrotomy following Urethroplasty were defined to have satisfactory outcome and were included in satisfactory result rate along with patients who had a successful outcome. Results were analyzed using unpaired t test, chi-square test, binary logistic regression, Kaplan–Meier curves, and log rank test. Results Previous interventions in the form of endoscopic realignment or Urethroplasty have significant adverse effect on the success rate of subsequent anastomotic Urethroplasty for post-traumatic posterior urethral strictures ( P Conclusions Previous failed railroading or Urethroplasty significantly decrease the success of subsequent anastomotic Urethroplasty. Hence, a primary realignment or Urethroplasty should be avoided in suboptimal conditions and the cases of post-traumatic urethral stricture should be referred to centers with such expertise.
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impact of prior urethral manipulation on outcome of anastomotic Urethroplasty for post traumatic urethral stricture
Urology, 2010Co-Authors: Bhupendra P Singh, Mukund G Andankar, Sanjaya K Swain, Vimal Dassi, Harish K Kaswan, Vipul Agrawal, Hemant R PathakAbstract:Objective To determine the impact of earlier urethral interventions on the outcomes of anastomotic Urethroplasty in post-traumatic stricture urethra. Methods From October 1995 to March 2008, a total of 58 patients with post-traumatic posterior urethral stricture underwent anastomotic Urethroplasty. Eighteen patients had earlier undergone urethral intervention in the form of urethrotomy (3), endoscopic realignment (7), or open Urethroplasty (8). Success was defined as no obstructive urinary symptoms, maximum urine flow rate ≥ 15 mL/s, normal urethral imaging and/or urethroscopy, and no need of any intervention in the follow-up period. Patients who met the above objective criteria after needing 1 urethrotomy following Urethroplasty were defined to have satisfactory outcome and were included in satisfactory result rate along with patients who had a successful outcome. Results were analyzed using unpaired t test, chi-square test, binary logistic regression, Kaplan–Meier curves, and log rank test. Results Previous interventions in the form of endoscopic realignment or Urethroplasty have significant adverse effect on the success rate of subsequent anastomotic Urethroplasty for post-traumatic posterior urethral strictures ( P Conclusions Previous failed railroading or Urethroplasty significantly decrease the success of subsequent anastomotic Urethroplasty. Hence, a primary realignment or Urethroplasty should be avoided in suboptimal conditions and the cases of post-traumatic urethral stricture should be referred to centers with such expertise.
Nicolaas Lumen - One of the best experts on this subject based on the ideXlab platform.
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Urethroplasty after urethral urolume stent an international multicenter experience
Urology, 2018Co-Authors: J C Angulo, Sanjay Kulkarni, Joshi Pankaj, Dmitriy Nikolavsky, Pedro Suarez, Javier Belinky, Ramon Virasoro, Jessica Delong, Francisco Martins, Nicolaas LumenAbstract:Objective To evaluate the outcomes and factors affecting success of Urethroplasty in patients with stricture recurrence after Urolume urethral stent. Material and Methods This is a retrospective international multicenter study on patients treated with urethral reconstruction after Urolume stent. Stricture and stent length, time between urethral stent insertion and Urethroplasty, age, mode of stent retrieval, type of Urethroplasty, complications and baseline, and postUrethroplasty voiding parameters were analyzed. Successful outcome was defined as standard voiding, without need of any postoperative adjunctive procedure. Results Sixty-three patients were included. Stent was removed at Urethroplasty in 61 patients. Reconstruction technique was excision and primary anastomosis in 14 (22.2%), dorsal onlay buccal mucosa graft (BMG) in 9 (14.3%), ventral onlay BMG in 6 (9.5%), dorsolateral onlay BMG in 9 (14.3%), ventral onlay plus dorsal inlay BMG in 3 (4.8%), augmented anastomosis in 5 (7.9%), pedicled flap Urethroplasty in 6 (9.5%), 2-stage procedure in 4 (6.4%), and perineal urethrostomy in 7(11.1%). Success rate was 81% at a mean 59.7 ± 63.4 months. Dilatation or internal urethrotomy was performed in 10 (15.9%) and redo-Urethroplasty in 5 (7.9%). Total International Prostate Symptom Score, quality of life, urine maximum flow, and postvoid residual significantly improved (P Conclusion Urethroplasty in patients with Urolume urethral stents is a viable option of reconstruction with a high success rate and very acceptable complication rate. Numerous techniques are viable; however, urethral preservation, tine-by-tine stent extraction, and use of BMG augmentation produced significantly better outcomes.
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buccal versus lingual mucosa graft in anterior Urethroplasty a prospective comparison of surgical outcome and donor site morbidity
The Journal of Urology, 2016Co-Authors: Nicolaas Lumen, Enzo Palminteri, Willem Oosterlinck, Piet Hoebeke, Stephanie Vierstraeteverlinde, Cedric Goes, Heleen Maes, Annefrancoise SpinoitAbstract:Purpose: We prospectively compared buccal mucosa graft and lingual mucosa graft Urethroplasty with respect to donor site morbidity and Urethroplasty outcome.Materials and Methods: Patients treated with buccal mucosa graft (29) or lingual mucosa graft (29) Urethroplasty were included in the study. Oral pain and morbidity were assessed using the numeric rating scale (scale 0 to 10) as well as an in-home questionnaire administered 3 days, 2 weeks and 6 months postoperatively.Results: After a mean (±SD) followup of 30 (±13) months successful Urethroplasty was achieved in 24 (82.8%) and 26 (89.7%) patients treated with buccal mucosa graft and lingual mucosa graft, respectively (p=0.306). Median numeric rating scale after 3 days, 2 weeks and 6 months was 4, 2 and 0 for buccal mucosa graft and 6, 3 and 0 for lingual mucosa graft, respectively, with no statistical differences between the groups. At day 3 significantly more patients in the lingual mucosa graft group had severe difficulties with eating and drinking...
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Urethroplasty for strictures after phallic reconstruction a single institution experience
European Urology, 2011Co-Authors: Nicolaas Lumen, Stan Monstrey, Ansofie Goessaert, Willem Oosterlinck, Piet HoebekeAbstract:Abstract Background Treatment recommendations for strictures after phalloplasty are lacking. Objective Our aim was to evaluate the outcome of Urethroplasty for strictures after phalloplasty and to provide treatment recommendations based on this experience. Design, setting, and participants One hundred and eighteen urethroplasties were performed in 79 patients. Mean patient age was 37.6 yr. Mean follow-up was 39 mo. Intervention Different types of Urethroplasty were used: meatotomy, Heineke-Mikulicz principle (HMP), excision and primary anastomosis (EPA), free graft Urethroplasty (FGU), pedicled flap Urethroplasty (PFU), two-stage Urethroplasty (TSU), and perineostomy followed by urethral reconstruction (PUR). Measurements Stricture recurrence was defined as the need for additional instrumentation or surgery. Results and limitations Mean stricture length was 3.6cm. Stricture location was at the meatus, phallic urethra, anastomosis, fixed part, and different locations in 18, 28, 48, 15, and 9 urethroplasties, respectively. Stricture recurrence was observed in 44 urethroplasties (41.12%). Stricture recurrence rate for meatotomy, HMP, EPA, FGU, PFU, TSU, and PUR was 25%, 42.11%, 42.86%, 50%, 40%, 30.3%, and 61.9%, respectively. Conclusions The main stricture location after phalloplasty is the anastomosis between the phallic and the fixed part. Urethroplasty for strictures after phalloplasty is associated with a relatively high recurrence rate. Trial registration EC UZG 2007/434.
A R Mundy - One of the best experts on this subject based on the ideXlab platform.
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what is the best technique for Urethroplasty
European Urology, 2008Co-Authors: Daniela E Andrich, A R MundyAbstract:Abstract Context There is no clear evidence that determines which type of Urethroplasty to perform under which particular circumstance. Objective To review the options for Urethroplasty at different sites in the urethra and for different types of stricture indicating which procedure should be used in which circumstances according to the best available evidence. Evidence acquisition Recent publications have been reviewed and supplemented with the authors' personal experience. Evidence synthesis Currently, in the developed world, the most common types of stricture are relatively short and are situated in the bulbar urethra. There is good evidence that these are best treated by excision and end-to-end anastomosis if they are short enough or by patch Urethroplasty using a buccal mucosal graft if they are longer. Distal penile urethral strictures are the next most common type of stricture, but the evidence base is weaker, although there is agreement that penile strictures due to lichen sclerosus often require a staged approach to reconstruction, again using buccal mucosal grafts. Urethroplasty for pelvic fracture urethral injury is an altogether different type of technique for an altogether different type of pathology. There is good evidence that this is best treated by bulbo-prostatic anastomotic Urethroplasty. Other types of strictures and salvage surgery have no good evidence base and are specialised areas where experience and judgement are necessary. Conclusions The evidence base for urethral surgery has been developed for the more common types of urethral strictures in the last 20 yr, but it is still as much an art as it is a science.
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repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost effective
The Journal of Urology, 2004Co-Authors: Tamsin Greenwell, Carissa Castle, J T Macdonald, David Nicol, Daniela E Andrich, A R MundyAbstract:PURPOSE: We developed an algorithm for the management of urethral stricture based on cost-effectiveness. MATERIALS AND METHODS: United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132). RESULTS: The costs were urethrotomy/urethral dilation 2,250.00 pounds sterling (3,375.00 dollars, ratio 1.00), simple 1-stage Urethroplasty 5,015.00 pounds sterling (7,522.50 dollars, ratio 2.23), complex 1-stage Urethroplasty 5,335.00 pounds sterling (8,002.50 dollars, ratio 2.37) and 2-stage Urethroplasty 10,370 pounds sterling (15,555.00 dollars, ratio 4.61). Of the 126 patients assessed 60 (47.6%) required more than 1 endoscopic retreatments (mean 3.13 each), 50 performed biweekly clean intermittent self-catheterization and 7 underwent Urethroplasty during followup. The total cost per patient for all 126 patients for stricture treatment during followup was 6,113 pounds sterling (9,170 dollars). This cost was calculated by multiplying procedure cost by the number of procedures performed. A strategy of urethrotomy or urethral dilation as first line treatment, followed by Urethroplasty for recurrence yielded a total cost per patient of 5,866 pounds sterling (8,799 dollars). CONCLUSIONS: A strategy of initial urethrotomy or urethral dilation followed by Urethroplasty in patients with recurrent stricture proves to be the most cost-effective strategy. This financially based strategy concurs with evidence based best practice for urethral stricture management.
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repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost effective
The Journal of Urology, 2004Co-Authors: Tamsin Greenwell, Carissa Castle, J T Macdonald, David Nicol, Daniela E Andrich, A R MundyAbstract:ABSTRACTPurpose:: We developed an algorithm for the management of urethral stricture based on cost-effectiveness.Materials and Methods:: United Kingdom medical and hospital costs associated with the current management of urethral stricture were calculated using private medical insurance schedules of reimbursement and clean intermittent self-catheterization supply costs. These costs were applied to 126 new patients treated endoscopically for urethral stricture in a general urological setting between January 1, 1991 and December 31, 1999. Treatment failure was defined as recurrent symptomatic stricture requiring further operative intervention following initial intervention. Mean followup available was 25 months (range 1 to 132).Results:: The costs were urethrotomy/urethral dilation £2,250.00 ($3,375.00, ratio 1.00), simple 1-stage Urethroplasty £5,015.00 ($7,522.50, ratio 2.23), complex 1-stage Urethroplasty £5,335.00 ($8,002.50, ratio 2.37) and 2-stage Urethroplasty £10,370 ($15,555.00, ratio 4.61). Of the...
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the long term results of Urethroplasty
The Journal of Urology, 2003Co-Authors: Daniela E Andrich, Tamsin Greenwell, N Dunglison, A R MundyAbstract:ABSTRACTPurpose: We update our long-term data on the effectiveness of Urethroplasty.Materials and Methods: A total of 166 patients operated on before 1990 are currently under followup or lived at least 10 years after surgery. Anastomotic Urethroplasty was performed in 82 patients and substitution Urethroplasty in 84.Results: The 5, 10 and 15-year re-stricture rates after anastomotic Urethroplasty were 12%, 13% and 14%, respectively, and the complication rate was 7%. The 5, 10 and 15-year re-stricture rates after substitution Urethroplasty were 21%, 31% and 58%, respectively, and the complication rate was 33%.Conclusions: The results of anastomotic Urethroplasty are good and sustained in the long term, while the results of substitution Urethroplasty deteriorate steadily with time and there is definite room for improvement. An anastomotic repair should be performed in preference to a substitution repair when possible.
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the problems of penile Urethroplasty with particular reference to 2 stage reconstructions
The Journal of Urology, 2003Co-Authors: Daniela E Andrich, Tamsin Greenwell, A R MundyAbstract:ABSTRACTPurpose: We evaluate the anecdotal high revision rate of 2-stage Urethroplasty.Materials and Methods: The short-term revision rates after 1-stage (139 cases) and 2-stage (103) urethroplasties were compared.Results: There were 4 revisions after 1-stage Urethroplasty (4 of 139, 3%) and all involved the penile urethra (20%). The revision rate was 37.8% after stage 1 and 25.3% after stage 2 and of 2-stage Urethroplasty 85%, involved the penile urethra.Conclusions: Although 2-stage has a significantly lower re-stricture rate than 1-stage Urethroplasty for complex strictures in the penile urethra, it does so at the expense of a significantly higher revision rate particularly of the penile urethra.
Allen F. Morey - One of the best experts on this subject based on the ideXlab platform.
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practice patterns in the treatment of urethral stricture among american urologists a paradigm change
Urology, 2015Co-Authors: Matthias D Hofer, Allen F. Morey, Daniel T Oberlin, Jaclyn Milose, Sarah C Flury, Christopher GonzalezAbstract:Objective To examine surgical case volume characteristics among certifying urologists associated with treatment of urethral stricture to compare practice patterns of recent graduates to recertifying attending urologists and trends over time. Materials and Methods Six-month case log data of certifying and recertifying urologists (2003-2013) were obtained from the American Board of Urology. Cases specifying a CPT code for urethral dilation, direct vision internal urethrotomy (DVIU), Urethroplasty, and graft harvest in males ≥18 years were analyzed for surgeon-specific variables. Results Among 6320 urologists logging at least one reconstructive urology procedure, 95,747 (86.2%) urethral dilations, 10,986 (10.0%) DVIU, and 4349 (3.9%) urethroplasties were identified, with 99 (0.9%) using graft and 405 (9.3%) staged procedures. Overall ratio of urethral dilation/DVIU to Urethroplasty was 24.5:1. More recent log year and new certification correlated with a decrease in ratio of dilation/DVIU to Urethroplasty, but stable use of graft. The ratio of dilation/DVIU to Urethroplasty for new certification was much lower (7.9:1), compared to first (24.4:1), second (63.3:1), and third recertification cycles (99.5:1), wherein Urethroplasty was increasingly rare. Newly certifying urologists performed Urethroplasty 4.5 times more often than those recertifying. Academically affiliated urologists were 8 times more likely to perform Urethroplasty. Conclusion Most urethral strictures are treated with dilation/DVIU, but a changing paradigm favoring Urethroplasty is evident. Most urethroplasties are performed by a small number of urologists with high volume, academic affiliation, recent residency graduation, and residence in a state with a reconstructive urology fellowship.
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advanced male urethral and genital reconstructive surgery
Published in 2014, 2014Co-Authors: Steven B Brandes, Allen F. MoreyAbstract:General Technical Considerations, Instrumentation and Decision Making in Urethroplasty Surgery -- Male Urethra and External Genitalia -- Vascular Anatomy of Genital Skin and the Urethra: Implications for Urethral Reconstruction -- Lichen Sclerosis -- Imaging of the Male Urethra -- Practical Plastic Surgery: Techniques for the Reconstructive Urologist -- The Epidemiology, Clinical Presentation and Economic Burden of Urethral Stricture -- Etiology, Histology and Classification of Urethral Stricture Disease -- Urethrotomy and other Minimally Invasive Interventions for Urethral Stricture -- Endourethral Prostheses for Urethral Stricture -- Fossa Navicaris and Meatal Reconstruction -- Stricture Excision and Primary Anastomosis for Anterior Urethral Strictures -- Oral Mucosal Graft Urethroplasty -- Lingual Grafts -- The Augmented Anastomotic Urethroplasty -- Penile Skin Flaps for Urethral Reconstruction -- Panurethral Strictures -- The Application of Muscular, Myocutaneous and Fasciocutaneous Flaps as Adjuncts in Complex Refractory Urethral Disorders -- Posterior Urethral Strictures -- Staged Urethroplasty -- Complications of Urethroplasty -- Postprostatectomy Strictures -- Radiotherapy induced Urethral Strictures: Urethroplasty and Minimally Invasive Methods -- Complex Urinary Fistulas of the Posterior Urethra and Bladder -- Reconstruction of Failed Urethroplasty -- Urethral Stent Complications and Methods for Explantation -- Reoperative Hypospadias Surgery and Management of Complications -- Follow-up Strategies after Urethral Stricture Treatment -- Urethral Rest as Precursor for Urethroplasty -- The Use of Patient Reported Outcome Measures in Men with Urethral Stricture Disease -- Reconstruction of Synchrous Urethral Strictures -- Perineal Urethrostomy -- Double Overlapping Buccal Grafts -- Reconstruction and Salvage of Failed Male Urethral Slings -- Primary and Secondary Reconstruction of the Neophallus Urethra -- Artificial Urinary Sphincters: Reoperative Techniques and Management of Complications -- Pediatric Urethral Strictures -- The Buried Penis in Adults -- Genital Skin Loss and Scrotal Reconstruction -- Surgery for Priapism -- Penile Skin Grafting and Resurfacing of the Glans -- Peyronie's Disease Reconstruction: Simple and Complex -- New Advances in Penile Implant Surgery -- Penile Fracture -- Muscle, Nerve and Vascular Sparing Techniques in Anterior Urethroplasty -- Tissue Engineering of the Urethra: The Basics, Current Concept, and the Future -- Non-transecting bulbar Urethroplasty -- Vascular Surgery For Erectile Dysfunction -- Penile and Inguinal Reconstruction and Tissue Preservation for Penile Cancer -- Post Prostatectomy Incontinence (evaluation and practical urodynamics).
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re outcome of 1 stage Urethroplasty using oral mucosal grafts for the treatment of urethral strictures associated with genital lichen sclerosus
The Journal of Urology, 2014Co-Authors: Allen F. MoreyAbstract:Objective To report the outcome of 1-stage Urethroplasty using lingual mucosal grafts (LMGs) and buccal mucosal grafts (BMGs) for the treatment of male urethral strictures associated with genital lichen sclerosus (LS). Materials and Methods This was a descriptive, observational retrospective study of male patients with urethral strictures who underwent 1-stage mucosal graft Urethroplasty using different substitute materials for reconstructive urethral surgery. Study inclusion criteria were patients with histologically proven LS presenting with urethral strictures. Exclusion criteria were patients without histologically proven LS, traumatic strictures, failed hypospadias, and malignant lesions. Successful reconstruction was defined as normal voiding with a peak flow >12 mL/s, no obstructive symptoms, and no postoperative procedure, including dilation. Results Between January 2003 and December 2011, urethral strictures in 54 patients were considered associated with genital LS according to the inclusion and exclusion criteria, and 36 underwent 1-stage Urethroplasty using oral mucosal grafts. The median age was 52 years (range, 32-80 years). The median stricture length was 12.5 ± 1.6 cm (range, 6-18 cm). One-stage single-sided dorsal LMG Urethroplasty was performed in 22 of 36 patients. The remaining 14 patients received the same procedure combined with dual BMGs (n = 5) or with LMG combined with BMG (n = 9). The success rate was 88.9%. Postoperative urinary fistula occurred in 1 patient, and meatal stenosis developed in 3 patients. Mean follow-up was 38.7 months (range, 12-110 months). Conclusion Our survey suggests that 1-stage Urethroplasty with single or combined LMGs or BMGs may be an effective option to treat urethral stricture associated with LS.
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re urethral rest role and rationale in preparation for anterior Urethroplasty
The Journal of Urology, 2011Co-Authors: Allen F. MoreyAbstract:Objectives To report the outcomes of men treated initially with a period of urethral rest to allow tissue recovery before anterior Urethroplasty. Many men referred to referral centers for anterior urethral reconstruction often present soon after the endoscopic manipulation of severe strictures. Methods We reviewed our database of all anterior urethroplasties performed by a single surgeon from 2007 to 2009. Urethral rest was accomplished by removal of the indwelling catheter, cessation of self-catheterization, and/or suprapubic urinary diversion before urethral reconstruction. Results During the study period, 210 patients underwent urethral reconstruction at our center. Men who had undergone meatoplasty or posterior Urethroplasty were excluded, leaving 128 anterior Urethroplasty patients available for analysis. Of these men, 28 (21%) were preoperatively given an initial period of urethral rest (median duration 3 months) because of recent urologic manipulation occurring immediately before referral. Of the 28 patients, 15 (54%) received suprapubic catheters. Urethral rest promoted identification of severely fibrotic stricture segments, enabling focal or complete excision in 75% (excision and primary anastomosis in 12 [43%] and augmented anastomosis in 9 [32%]), a percentage similar to that for those undergoing reconstruction without preliminary manipulation mandating urethral rest (82%). Stricture recurrence developed in 4 (14%) of the 28 rest patients, a rate again similar to that for the remainder of the Urethroplasty population (10%). Conclusions The results of our study have shown that recently manipulated anterior urethral strictures often declare themselves to be obliterative within several months of urethral rest, thus enabling successful Urethroplasty by focal or complete excision.
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erectile function after anterior Urethroplasty
The Journal of Urology, 2001Co-Authors: John W Coursey, Jack W Mcaninch, Allen F. Morey, Duncan J Summerton, Charles L Secrest, Paige C White, Kennon S Miller, Christopher Pieczonka, David A Hochberg, Noel A ArmenakasAbstract:Purpose: We ascertained the impact of anterior Urethroplasty on male sexual function.Materials and Methods: A validated questionnaire was mailed to 200 men who underwent anterior Urethroplasty to evaluate postoperative sexual function. Questions addressed the change in erect penile length and angle, patient satisfaction with erection, preoperative and postoperative coital frequency, and change in erection noted by the sexual partner. Results were stratified by the urethral reconstruction method, namely anastomosis, buccal mucosal graft, penile flap and all others, and compared with those in a similar group of men who underwent circumcision only.Results: Of the 200 men who underwent Urethroplasty 152 who were 17 to 83 years old (mean age 45.7) completed the questionnaire. Average followup was 36 months (range 3 to 149). Overall there was a similar incidence of sexual problems after Urethroplasty and circumcision. Penile skin flap Urethroplasty was associated with a slightly higher incidence of impaired sex...
