Silke Riechardt

Outcomes of Ventral Onlay Buccal Mucosa Graft Urethroplasty in Patients after Radiotherapy

PURPOSE We evaluated stricture-free survival and functional outcomes of buccal mucosa graft urethroplasty in patients with urethral stricture disease after radiotherapy. MATERIALS AND METHODS We reviewed our urethroplasty database for patients with a radiotherapy history who underwent buccal mucosa graft urethroplasty between January 2009 and October 2013. We reviewed patient charts and the institutional, standardized, nonvalidated questionnaires administered to each patient postoperatively. Study end points included 1) the success rate, 2) continence status, 3) erectile function and 4) patient satisfaction postoperatively. Success was defined as stricture-free survival. RESULTS Of 38 men included in the study prostate cancer was the most common indication for radiotherapy in 35 (92.1%). External beam radiotherapy was performed in 24 cases (64.9%), brachytherapy was done in 8 (21.6%) and a combination of the 2 treatments was performed in 6 (13.5%). Strictures were in the bulbar/bulbomembranous urethra and had a median length of 3.0 cm (range 1.0 to 8.0). The overall success rate was 71.1% at a median followup of 26.5 months (range 1.0 to 50.0). Median time to stricture recurrence was 17.0 months (range 3.0 to 44.0). De novo urinary incontinence was observed in 4 patients (10.5%). Erectile function remained mostly unchanged compared to preoperative status. Study limitations include the small sample size and the lack of validated questionnaires. CONCLUSIONS At short-term to mid-term followup the success rate of ventral onlay buccal mucosa graft urethroplasty in patients with radiotherapy history seems acceptable. However, patients must be counseled about the increased risk of urinary incontinence. Longer followup is warranted to address long-term outcomes.

Two-stage urethroplasty with buccal mucosa.

A two-stage urethroplasty with buccal mucosa is indicated in patients with complex stricture disease or failed hypospadias repair. Long urethral strictures with severe spongiofi brosis after previous surgical repairs, in whom no healthy tissue remains, need a two-stage intervention. Hypospadias cripples with no urethral plate or complete breakdown of other urethral reconstructions with scars and spongiofi brosis are also suitable for this procedure.

Dorsal buccal mucosal inlay for penile urethroplasty

We present a modification of the original technique that simplifies the anastomosis and accelerates the whole procedure. buccal mucosal graft is sutured to the tunica albuginea using interrupted sutures, the right mucosal margin of the urethra is sutured to the right side of the graft, the urethra rotated back and the left urethral margin sutured to the left side of the graft. A 16 F catheter is left in place [1].

Etiology and outcome of the perineal repair of posterior and bulbar urethral strictures in children: A single surgeon experience

OBJECTIVE To evaluate the etiology of posterior and/or bulbar strictures in children in an industrialized country and assess the outcome of its repair by perineal approach. Urethral strictures in children are rare and often challenging to treat. Trauma is the main etiology in developing countries. However, data for industrialized countries are sparse. MATERIAL AND METHODS Retrospective analysis of 17 patients treated with perineal urethroplasty 2001-2010. Data were assessed by chart review and non-validated standardized questionnaire. Hypospadias cases were excluded. Reconstruction was performed by stricture excision and primary anastomosis, or a single-staged or two-staged buccal mucosa graft. RESULTS Mean age at surgery was 7.9 years (range 1-13) and mean follow-up was 42.6 months (4-115). Eight patients (47.1%) had post-traumatic strictures, five (29.4%) had a history of posterior valves, and previous transurethral catheterization and irradiation each accounted for one patient (5.9%). In the remaining two (11.8%), the etiology was unknown. The success rate was 88.9%. All but one patient were continent postoperatively. CONCLUSIONS Most common etiology for open urethral reconstruction in children was trauma and previous valve treatment. In our hands the perineal approach for stricture repair is safe and successful. Stricture recurrence rate is low, and incontinence is only associated with additional bladder neck trauma.

Urethral 'cripples': two-staged procedures.

Purpose of review To review the current literature on staged procedures in patients with previous urethral interventions (‘urethral cripples’). Recent findings Five studies published during the past 18 months could be identified, the majority with short-term follow-up and small patient numbers. Four studies investigated the outcome after redo surgery in hypospadias patients, one study after urethral stricture disease. Summary The few data published suggest acceptable complication rate and success rate for surgical outcome. Long-term and prospective data with special respect to sexual function, patient satisfaction, and quality of life are still lacking.

Lage- und Verschmelzungsanomalien der Nieren

Eine auserhalb der normalen Position befindliche Niere wird als Nierendystopie oder Nierenektopie bezeichnet (Beckenniere, thorakale Niere). Eine gekreuzte renale Ektopie liegt vor, wenn der Ureter zum Ostium der Gegenseite kreuzt. Hierbei wird die Mittellinie uberquert. In 90 % der Falle besteht dabei eine zusatzliche Fusionsanomalie mit der ipsilateralen Niere (S-Niere, L-Niere); cave: abnormale Gefasversorgung. Eine Fusion ohne Ektopie stellt z. B. die Hufeisenniere oder Kuchenniere dar. In der Diagnostik steht die Sonographie an vorderster Stelle, das i.v. Urogramm hat nur beim Erwachsenen Bedeutung. Zusatzliche Untersuchungen wie Nierenfunktionsprufung oder MRT konnen je nach Symptomatik erforderlich sein.

90 OUTCOME OF CONTEMPORARY URETHROPLASTY AT A TERTIARY CARE CENTER

INTRODUCTION AND OBJECTIVES: To evaluate the stricture free survival rate, adverse events and quality of life (QoL) of urethroplasty in the short term follow-up. METHODS: We retrospectively evaluated our patients who underwent urethroplasty between 12/08 and 07/10 at the University Medical Center Hamburg-Eppendorf, Germany. A standardized nonvalidated questionnaire was sent to all patients in September 2010. Primary end point was the stricture free survival rate, defined as no stricture recurrence. Secondary endpoints were adverse events and QoL. RESULTS: Within 19 months 205 patients underwent urethroplasty due to urethral stricture at different localisations and extend. One hundred forty four patients (70%) with a mean age of 56 years (range 14–84) and a mean follow up of 10.2 months (1–22), responded to our questionnaire. Of this cohort 9%, 85% and 6% were treated by primary excision and re-anastomosis (EPA), buccal mucosa graft (BMG) and mesh graft (MG) urethroplasty, respectively. Overall, 18/144 (12.5%) recurrences were documented and specifically 0%, 14.3% and 12.5 % for EPA, BMG and MG. In Kaplan Meier analysis there was no statistical significant difference concerning the stricture recurrence free survival between the three surgical techniques. Furthermore, no risk factor as localisation, stricture length and number of previous surgeries was identified for early stricture recurrence. Adverse events as incontinence, curvature, shortening and post void wiping out of the urethra were most often associated with MG urethroplasty. However, statistical significant difference was not shown (p 0.05). Neither, there was a statistical significant difference found in QoL nor satisfaction with surgical outcome between the three techniques of urethroplasty (p 0.7). CONCLUSIONS: At our center contemporary urethral surgery signifies a BMG for the majority of patients. Stricture recurrence free survival for EPA, BMG and MG seems comparable. However, EPA demonstrates excellent success rates of urethroplasty in the short term follow up. Differences in adverse events are not statistically significant between EPA, BMG and MG and do not seem to have an impact on quality of life and satisfaction of surgical outcome.