Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.10.003
G. Mantica , F. Chierigo , Ł. Białek , F.X. Madec , M. Frankiewicz , W. Verla , E.J. Redmond , C.M. Rosenbaum , A. Cocci , F. Campos-Juanatey , M. Oszczudłowski , J. Adamowicz , C. Terrone , M.W. Vetterlein , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología
Objective
The aim of this systematic review is to offer a comprehensive view of the current use of robotic surgery for the treatment of urethral strictures and bladder neck contractures.
Methods
A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Embase databases in December 2023. Keywords used were ‘robotic’ and ‘robotic-assisted’ combined with ‘urethroplasty’, ‘urethral stricture’, and ‘bladder neck contracture’. All papers published after 2000, concerning studies conducted on humans for urethral strictures and bladder neck contractures managed with robotic surgery were considered for the review. Only procedures involving a direct approach to urethra/bladder neck and/or graft harvesting for urethroplasty have been included.
Results
A total of 275 articles were evaluated after the strategy search and only 11 articles were considered eligible for the final analysis. The studies included a series of between a minimum of 1 and a maximum of 104 patients, for a total of 203 patients. The robotic surgery was performed mainly for the treatment of bladder neck contracture and posterior urethra. In some reports, the robotic system was used for graft harvesting, subsequently used with an open perineal technique. The follow-up presented in the different studies is very heterogeneous. However, most studies have high success rates, with recurrence and redo surgery rates generally below 20%. Likewise, post-procedure incontinence rates are low.
Conclusions
The outcomes presented in the literature, combined with the minimally invasive nature, suggest a possible growing role for robotic surgery in the coming years in the treatment of these diseases.
{"title":"El uso de la cirugía robótica para el tratamiento de estenosis uretrales y contracturas del cuello vesical: una revisión sistemática","authors":"G. Mantica , F. Chierigo , Ł. Białek , F.X. Madec , M. Frankiewicz , W. Verla , E.J. Redmond , C.M. Rosenbaum , A. Cocci , F. Campos-Juanatey , M. Oszczudłowski , J. Adamowicz , C. Terrone , M.W. Vetterlein , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología","doi":"10.1016/j.acuro.2024.10.003","DOIUrl":"10.1016/j.acuro.2024.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this systematic review is to offer a comprehensive view of the current use of robotic surgery for the treatment of urethral strictures and bladder neck contractures.</div></div><div><h3>Methods</h3><div>A systematic review of the current literature was conducted through the Medline and NCBI PubMed, Embase databases in December 2023. Keywords used were ‘robotic’ and ‘robotic-assisted’ combined with ‘urethroplasty’, ‘urethral stricture’, and ‘bladder neck contracture’. All papers published after 2000, concerning studies conducted on humans for urethral strictures and bladder neck contractures managed with robotic surgery were considered for the review. Only procedures involving a direct approach to urethra/bladder neck and/or graft harvesting for urethroplasty have been included.</div></div><div><h3>Results</h3><div>A total of 275 articles were evaluated after the strategy search and only 11 articles were considered eligible for the final analysis. The studies included a series of between a minimum of 1 and a maximum of 104 patients, for a total of 203 patients. The robotic surgery was performed mainly for the treatment of bladder neck contracture and posterior urethra. In some reports, the robotic system was used for graft harvesting, subsequently used with an open perineal technique. The follow-up presented in the different studies is very heterogeneous. However, most studies have high success rates, with recurrence and redo surgery rates generally below 20%. Likewise, post-procedure incontinence rates are low.</div></div><div><h3>Conclusions</h3><div>The outcomes presented in the literature, combined with the minimally invasive nature, suggest a possible growing role for robotic surgery in the coming years in the treatment of these diseases.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 11-19"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.10.002
E. Bohane , M. Murphy , F. Chierigo , G. Mantica , J. Adamowicz , F. Campos-Juanatey , A. Cocci , M. Frankiewicz , C.M. Rosenbaum , W. Verla , M. Waterloos , Ł. Białek , F.X. Madec , M. Oszczudłowski , M.W. Vetterlein , E.J. Redmond , en nombre del Trauma and Reconstructive Urology Working Party de la European Association of Urology Young Academic Urologists
Introduction
The goal of hypospadias repair is to optimize urinary and sexual function, improve cosmesis and minimise the psychosocial effects associated with a penile anomaly. However, a lack of clarity exists regarding the role of surgery in milder hypospadias where the anomaly is inconspicuous and there is no anticipated impact on function. The aim of this study was to review the long term functional, cosmetic and psychosocial outcomes in men with uncorrected hypospadias. This information may be helpful for parents who are burdened with deciding the correct treatment for their child's hypospadias.
Methods
A scoping review of PubMed, EMBASE, and CINAHL+ databases was performed in adherence with PRISMA guidelines. Eight studies were identified for inclusion in the review.
Results
Men with mild uncorrected hypospadias have similar functional outcomes to those without hypospadias, preferring to void standing and reporting similar IPSS scores. However, those with severe untreated hypospadias experience significant urinary difficulties, higher IPSS scores, and are more likely to sit when voiding. They reported worse SHIM scores, more ventral curvature, and greater difficulty with intercourse. Most men with incidentally identified hypospadias are unaware of their condition and are satisfied with their penile appearance. There was no difference in the attainment of psychosocial milestones between men with uncorrected hypospadias versus no hypospadias.
Conclusion
There is a lack of research regarding the experiences of adult men with uncorrected hypospadias. However, there is some evidence to support the non-operative management of mild hypospadias. Therefore, the decision to defer surgery in infancy should balance parental wishes and physician guidance, particularly in cases where the risk of functional impairment is low.
{"title":"Resultados a largo plazo de hipospadias no intervenidos: una revisión exploratoria","authors":"E. Bohane , M. Murphy , F. Chierigo , G. Mantica , J. Adamowicz , F. Campos-Juanatey , A. Cocci , M. Frankiewicz , C.M. Rosenbaum , W. Verla , M. Waterloos , Ł. Białek , F.X. Madec , M. Oszczudłowski , M.W. Vetterlein , E.J. Redmond , en nombre del Trauma and Reconstructive Urology Working Party de la European Association of Urology Young Academic Urologists","doi":"10.1016/j.acuro.2024.10.002","DOIUrl":"10.1016/j.acuro.2024.10.002","url":null,"abstract":"<div><h3>Introduction</h3><div>The goal of hypospadias repair is to optimize urinary and sexual function, improve cosmesis and minimise the psychosocial effects associated with a penile anomaly. However, a lack of clarity exists regarding the role of surgery in milder hypospadias where the anomaly is inconspicuous and there is no anticipated impact on function. The aim of this study was to review the long term functional, cosmetic and psychosocial outcomes in men with uncorrected hypospadias. This information may be helpful for parents who are burdened with deciding the correct treatment for their child's hypospadias.</div></div><div><h3>Methods</h3><div>A scoping review of PubMed, EMBASE, and CINAHL+ databases was performed in adherence with PRISMA guidelines. Eight studies were identified for inclusion in the review.</div></div><div><h3>Results</h3><div>Men with mild uncorrected hypospadias have similar functional outcomes to those without hypospadias, preferring to void standing and reporting similar IPSS scores. However, those with severe untreated hypospadias experience significant urinary difficulties, higher IPSS scores, and are more likely to sit when voiding. They reported worse SHIM scores, more ventral curvature, and greater difficulty with intercourse. Most men with incidentally identified hypospadias are unaware of their condition and are satisfied with their penile appearance. There was no difference in the attainment of psychosocial milestones between men with uncorrected hypospadias versus no hypospadias.</div></div><div><h3>Conclusion</h3><div>There is a lack of research regarding the experiences of adult men with uncorrected hypospadias. However, there is some evidence to support the non-operative management of mild hypospadias. Therefore, the decision to defer surgery in infancy should balance parental wishes and physician guidance, particularly in cases where the risk of functional impairment is low.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 1-10"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.10.006
E. Fes Ascanio , L.E. Ortega Polledo , M.E. Zegrí de Olivar , C.A. Muñoz Bastidas , E. Seguí Moya , D.M. Carrión Monsalve , M. Sánchez García , F. Campos-Juanatey
Introduction and objective
Assessment of urethral stricture (US) management in a specific group of professionals, Urology Residents, in a specific region (Spain), seems to be important to determine the quality of the educational program and design educational interventions to improve it. We aim to investigate diagnosis and therapeutics practices among Urology Residents for the US management.
Materials and methods
20-question on-line survey was conducted among residents and junior consultants registered on the mailing list of residents and young urologists of the Spanish Association of Urology (RAEU) group of the educational period 2018-2023. We evaluated demographic, educational, surgical technics and experience data during the training period. 290 questionnaires were mailed between May-August 2023. Data was collected in a prospective way between May-December 2023, with 29,6% response rate.
Results
The survey obtained 86 responders, with 29,65% (86/290) response rate. Two first sections were answered by all the responders, however, from the assessment section on, only 57 responders completed the survey, which represents 66,28% of them.
Conclusions
Educational program in Reconstructive Urology among Urology Residents in Spain has an improvement margin. We must dedicate our efforts to standardize the educational process and facilitate access to formation to and increasing area of interest among residents.
{"title":"Estado actual de la formación en cirugía reconstructiva en España: resultados de una encuesta nacional","authors":"E. Fes Ascanio , L.E. Ortega Polledo , M.E. Zegrí de Olivar , C.A. Muñoz Bastidas , E. Seguí Moya , D.M. Carrión Monsalve , M. Sánchez García , F. Campos-Juanatey","doi":"10.1016/j.acuro.2024.10.006","DOIUrl":"10.1016/j.acuro.2024.10.006","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>Assessment of urethral stricture (US) management in a specific group of professionals, Urology Residents, in a specific region (Spain), seems to be important to determine the quality of the educational program and design educational interventions to improve it. We aim to investigate diagnosis and therapeutics practices among Urology Residents for the US management.</div></div><div><h3>Materials and methods</h3><div>20-question on-line survey was conducted among residents and junior consultants registered on the mailing list of residents and young urologists of the Spanish Association of Urology (RAEU) group of the educational period 2018-2023. We evaluated demographic, educational, surgical technics and experience data during the training period. 290 questionnaires were mailed between May-August 2023. Data was collected in a prospective way between May-December 2023, with 29,6% response rate.</div></div><div><h3>Results</h3><div>The survey obtained 86 responders, with 29,65% (86/290) response rate. Two first sections were answered by all the responders, however, from the assessment section on, only 57 responders completed the survey, which represents 66,28% of them.</div></div><div><h3>Conclusions</h3><div>Educational program in Reconstructive Urology among Urology Residents in Spain has an improvement margin. We must dedicate our efforts to standardize the educational process and facilitate access to formation to and increasing area of interest among residents.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 86-93"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.10.005
W. Verla , N. Lumen , M. Waterloos , J. Adamowicz , F. Campos-Juanatey , A. Cocci , M. Frankiewicz , G. Mantica , C. Rosenbaum , F.X. Madec , E. Redmond , Ł. Białek , F. Chierigo , M. Oszczudłowski , M. Vetterlein , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología
Introduction
Neo-urethral stricture formation frequently occurs after phalloplasty and most commonly affects the anastomosis between the fixed and phallic part of the neo-urethra. This narrative review gives an overview of the existing literature on how to treat these particular strictures.
Methods
This narrative review is based on a literature search conducted in June 2024. No restrictions in terms of publication date, language or sample size were applied.
Results
Treatment options include direct vision internal urethrotomy, anastomotic repair urethroplasty, augmentation urethroplasty with grafts or flaps, multi-stage urethroplasty and urethrostomy. Overall, outcomes of these treatments are worse in transmen than in cismen, mainly due to the specific challenges posed by the neophallus environment. Generally, limited data are available on the treatment options for patients with anastomotic strictures after phalloplasty and, consequently, no clear recommendations can be made.
Conclusion
This narrative review provides a comprehensive and up-to-date overview of the available literature, which may guide future research and help optimize the outcomes for patients with this complex problem after phalloplasty.
{"title":"Tratamiento de la estenosis anastomótica tras faloplastia: una revisión actualizada de la literatura","authors":"W. Verla , N. Lumen , M. Waterloos , J. Adamowicz , F. Campos-Juanatey , A. Cocci , M. Frankiewicz , G. Mantica , C. Rosenbaum , F.X. Madec , E. Redmond , Ł. Białek , F. Chierigo , M. Oszczudłowski , M. Vetterlein , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología","doi":"10.1016/j.acuro.2024.10.005","DOIUrl":"10.1016/j.acuro.2024.10.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Neo-urethral stricture formation frequently occurs after phalloplasty and most commonly affects the anastomosis between the fixed and phallic part of the neo-urethra. This narrative review gives an overview of the existing literature on how to treat these particular strictures.</div></div><div><h3>Methods</h3><div>This narrative review is based on a literature search conducted in June 2024. No restrictions in terms of publication date, language or sample size were applied.</div></div><div><h3>Results</h3><div>Treatment options include direct vision internal urethrotomy, anastomotic repair urethroplasty, augmentation urethroplasty with grafts or flaps, multi-stage urethroplasty and urethrostomy. Overall, outcomes of these treatments are worse in transmen than in cismen, mainly due to the specific challenges posed by the neophallus environment. Generally, limited data are available on the treatment options for patients with anastomotic strictures after phalloplasty and, consequently, no clear recommendations can be made.</div></div><div><h3>Conclusion</h3><div>This narrative review provides a comprehensive and up-to-date overview of the available literature, which may guide future research and help optimize the outcomes for patients with this complex problem after phalloplasty.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 35-41"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.04.002
J. Klemm, P. Marks, R.J. Schulz, D.K. Filipas, D.R. Stelzl, R. Dahlem, M. Fisch, M.W. Vetterlein, en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología
Introduction and objectives
Female urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center.
Patients and methods
We conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009–2023. We assessed objective (retreatment-free survival, improvement in maximum flow rate) and subjective outcomes (validated patient-reported outcomes).
Results
Of 12 women, 83 and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25 and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2 cm At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate was 10 ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction.
Conclusions
Buccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.
{"title":"Uretroplastia femenina con injerto de mucosa oral en una etapa: resultados comunicados por las pacientes y tasas de éxito funcional a largo plazo","authors":"J. Klemm, P. Marks, R.J. Schulz, D.K. Filipas, D.R. Stelzl, R. Dahlem, M. Fisch, M.W. Vetterlein, en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología","doi":"10.1016/j.acuro.2024.04.002","DOIUrl":"10.1016/j.acuro.2024.04.002","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Female urethral strictures are a rare condition that significantly impacts patients’ quality of life. Patient-reported outcomes are crucial, yet data regarding sexual function and treatment satisfaction are scarce. We aimed to provide insights from a reconstructive referral center.</div></div><div><h3>Patients and methods</h3><div>We conducted a retrospective analysis of women treated with ventral onlay one-stage buccal mucosa graft urethroplasty for urethral strictures between 2009–2023. We assessed objective (retreatment-free survival, improvement in maximum flow rate) and subjective outcomes (validated patient-reported outcomes).</div></div><div><h3>Results</h3><div>Of 12 women, 83 and 17% had iatrogenic and idiopathic strictures, respectively. Median number of prior interventions was 6. Strictures were located meatal and mid-urethral in 25 and 75%, respectively, 22% had the bladder neck involved. Median graft length was 2<!--> <!-->cm At median follow-up of 66 months, 33% of patients underwent stricture retreatment, but only one case occurred within the first 2 years postoperatively. The median improvement in maximum flow rate was 10<!--> <!-->ml/s. Median International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) scores were 8 for filling symptoms, 6 for voiding symptoms, and 3 for incontinence symptoms. Median ICIQ-FLUTSsex score was 4. Higher scores indicate a higher symptom burden. Median ICIQ-Satisfaction outcome and satisfaction scores were 18 and 7, respectively, reflecting high treatment satisfaction.</div></div><div><h3>Conclusions</h3><div>Buccal mucosal graft urethroplasty by ventral onlay for female urethral strictures yields effective, durable, and positively received outcomes. However, larger studies across multiple institutions are necessary to further assess its efficacy, especially regarding patient-reported experiences and sexual function.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 72-79"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141049511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.10.004
M. Frankiewicz , J. Adamowicz , L. Białek , F. Campos-Juanatey , F. Chierigo , A. Cocci , F.X. Madec , G. Mantica , M. Oszczudłowski , E.J. Redmond , C.M. Rosenbaum , W. Verla , M. Waterloos , M. Jobczyk , A. Kałużny , M.W. Vetterlein , M. Matuszewski , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología
Introduction
Oral mucosal grafts are essential in reconstructive urology, particularly for urethral and genital defects. Advances in harvesting and implantation techniques have been made, yet perioperative care remains crucial for optimal outcomes. This systematic review explores postoperative care pathways following oral mucosal graft harvesting to consolidate knowledge, identify best practices, and highlight research gaps.
Objective
The review aims to identify optimal care pathways, compare different oral care approaches, and address research gaps.
Methods
A systematic literature search was conducted using PubMed, Scopus, and Web of Science databases without time constraints. Key search terms included «oral mucosal graft», «oral care pathways», «OMG post-operative care», «BMG», «LMG», and «OMG graft harvesting». Selection followed PRISMA guidelines. Inclusion criteria focused on studies addressing oral mucosal grafts in reconstructive urology and associated perioperative care, excluding non-English articles, case reports, and editorials.
Results
The review underscores the suitability of oral mucosa for grafting due to properties like excellent vascularization and minimal immunogenicity. Comparisons among graft harvesting sites reveal differences in tissue quality, ease of harvest, and donor site morbidity. Non-closure techniques generally result in less postoperative pain and quicker healing, though closure might better control bleeding and infection. Despite common complications such as mild trismus and altered chewing efficiency, patient satisfaction remains high.
Conclusions
Effective management of oral mucosal grafts harvesting emphasizes tailored perioperative care to minimize complications and enhance recovery. Further research should focus on long-term oral morbidity, standardized care protocols, and patient-reported outcomes to improve care pathways and surgical results.
{"title":"Vías clínicas para el cuidado oral en pacientes sometidos a extracción de injerto de mucosa oral: una revisión sistemática","authors":"M. Frankiewicz , J. Adamowicz , L. Białek , F. Campos-Juanatey , F. Chierigo , A. Cocci , F.X. Madec , G. Mantica , M. Oszczudłowski , E.J. Redmond , C.M. Rosenbaum , W. Verla , M. Waterloos , M. Jobczyk , A. Kałużny , M.W. Vetterlein , M. Matuszewski , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología","doi":"10.1016/j.acuro.2024.10.004","DOIUrl":"10.1016/j.acuro.2024.10.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Oral mucosal grafts are essential in reconstructive urology, particularly for urethral and genital defects. Advances in harvesting and implantation techniques have been made, yet perioperative care remains crucial for optimal outcomes. This systematic review explores postoperative care pathways following oral mucosal graft harvesting to consolidate knowledge, identify best practices, and highlight research gaps.</div></div><div><h3>Objective</h3><div>The review aims to identify optimal care pathways, compare different oral care approaches, and address research gaps.</div></div><div><h3>Methods</h3><div>A systematic literature search was conducted using PubMed, Scopus, and Web of Science databases without time constraints. Key search terms included «oral mucosal graft», «oral care pathways», «OMG post-operative care», «BMG», «LMG», and «OMG graft harvesting». Selection followed PRISMA guidelines. Inclusion criteria focused on studies addressing oral mucosal grafts in reconstructive urology and associated perioperative care, excluding non-English articles, case reports, and editorials.</div></div><div><h3>Results</h3><div>The review underscores the suitability of oral mucosa for grafting due to properties like excellent vascularization and minimal immunogenicity. Comparisons among graft harvesting sites reveal differences in tissue quality, ease of harvest, and donor site morbidity. Non-closure techniques generally result in less postoperative pain and quicker healing, though closure might better control bleeding and infection. Despite common complications such as mild trismus and altered chewing efficiency, patient satisfaction remains high.</div></div><div><h3>Conclusions</h3><div>Effective management of oral mucosal grafts harvesting emphasizes tailored perioperative care to minimize complications and enhance recovery. Further research should focus on long-term oral morbidity, standardized care protocols, and patient-reported outcomes to improve care pathways and surgical results.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 20-34"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.11.001
R.G. Gómez, L.G. Velarde, R.A. Campos, R. Massouh, V. Humerez, V. Barrientos
Objective
To the present long-term outcomes of the vascular-sparing approach during reconstruction of pelvic fracture urethral injuries (PFUI) described by Gomez et al.
Material and methods
Anastomotic reconstruction of PFUI is performed without transecting the bulb of the spongiosum, to preserve the antegrade flow of the bulbar arteries. After exposure of the urethra, the bulbar arteries are located using a Doppler stethoscope. The bulb is mobilized dorsally and unilaterally, sacrificing the artery with the weaker Doppler signal to preserve the best contralateral artery. Occasionally, both arteries can be preserved. Removal of all fibrosis and anastomosis is performed as described in the traditional transecting technique.
Results
A total of 60 patients were included, with a mean age of 37 years (IQR: 22-48). The median time from trauma to urethral reconstruction was 16 weeks, and the mean stenosis length was 2.5 cm (IQR: 2-3). The left bulbar artery was preserved in 27 cases, the right bulbar artery in 8, and both in 24. There were postoperative complications in 14 cases (23%), but only one of them was Clavien ≥ III. With a mean follow-up of 56 months (IQR: 12-87), only one patient failed due to stenosis (98% success).
Conclusion
Preservation of antegrade arterial flow to the corpus spongiosum during PFUI reconstruction is feasible and safe. Although slightly more elaborate, this technique could reduce the risk of ischemic failure of reconstruction.
{"title":"Resultado de la preservación de las arterias bulbares durante la uretroplastia anastomótica para la lesión uretral por fractura de pelvis","authors":"R.G. Gómez, L.G. Velarde, R.A. Campos, R. Massouh, V. Humerez, V. Barrientos","doi":"10.1016/j.acuro.2024.11.001","DOIUrl":"10.1016/j.acuro.2024.11.001","url":null,"abstract":"<div><h3>Objective</h3><div>To the present long-term outcomes of the vascular-sparing approach during reconstruction of pelvic fracture urethral injuries (PFUI) described by Gomez et al.</div></div><div><h3>Material and methods</h3><div>Anastomotic reconstruction of PFUI is performed without transecting the bulb of the spongiosum, to preserve the antegrade flow of the bulbar arteries. After exposure of the urethra, the bulbar arteries are located using a Doppler stethoscope. The bulb is mobilized dorsally and unilaterally, sacrificing the artery with the weaker Doppler signal to preserve the best contralateral artery. Occasionally, both arteries can be preserved. Removal of all fibrosis and anastomosis is performed as described in the traditional transecting technique.</div></div><div><h3>Results</h3><div>A total of 60 patients were included, with a mean age of 37<!--> <!-->years (IQR: 22-48). The median time from trauma to urethral reconstruction was 16<!--> <!-->weeks, and the mean stenosis length was 2.5<!--> <!-->cm (IQR: 2-3). The left bulbar artery was preserved in 27<!--> <!-->cases, the right bulbar artery in 8, and both in 24. There were postoperative complications in 14<!--> <!-->cases (23%), but only one of them was Clavien ≥<!--> <!-->III. With a mean follow-up of 56<!--> <!-->months (IQR: 12-87), only one patient failed due to stenosis (98% success).</div></div><div><h3>Conclusion</h3><div>Preservation of antegrade arterial flow to the corpus spongiosum during PFUI reconstruction is feasible and safe. Although slightly more elaborate, this technique could reduce the risk of ischemic failure of reconstruction.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 102-107"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.10.007
A. García Fernández , F. Campos-Juanatey , P. Calleja Hermosa , A. González Fernández , R. Varea Malo , J.L. Gutiérrez Baños
Introduction
Direct vision internal urethrotomy (DVIU) is usually the first treatment offered to patients with bulbar urethral strictures (US). Advances in devices and surgical techniques have contributed to reducing associated complications. Despite the favorable success rate of DVIU, various factors predicting better outcomes have been studied, including patient characteristics, stricture features, and procedural aspects. The main aim of our study is to assess predictive factors for success.
Methods
We conducted a retrospective descriptive study of patients who underwent endoscopic internal urethrotomy at our hospital over a 30 year period. Out of 788 DVIU performed, we selected 491 (62.3%) conducted for bulbar US with a minimum follow-up of 12 months. We examined clinical outcomes obtained, and assessed the relationship between different patient characteristics, stricture-related factors and procedural aspects related with clinical success -considered as the avoidance of further interventions for stricture recurrence-. Descriptive statistics were calculated and parametrical and non-parametrical comparative tests were applied. Kaplan-Meier survival analysis was used for evaluating time until recurrence.
Results
Mean stricture length was 1.2 cm (SD 0.5), with only 12 patients presenting with more than 1 US in the bulbar area during DVIU. After a median follow-up of 170 months, 67.4% of patients did not experience clinical recurrence. Severe postoperative complications appear in 0.4% of cases, and need for overnight admission was 4.5%. A positive association was observed between clinical recurrence and a history of prior pelvic radiotherapy (OR 2.8, 95%IC 1.3-22.2), active smoking (OR 2.1, 95% IC 1.6-2.4), infectious etiology of stricture (OR 2.3, 95% IC 1.6-8), history of previous urethroplasty (OR 2.5, 95% IC 1.7-3.2), and higher postoperative urinary catheter sizes (OR 1.8 95% IC 1.1-2.9). Median time until recurrence after the first DVIU was 65 months, after the second was 60 months, after the third was 32 months, and after the fourth was 6 months.
Conclusions
Bulbar US could be safely managed with DVIU. The best clinical success is achieved in non-irradiated, non-smoker patients, without prior urethroplasties. The repetition of the procedure is significantly associated with a shorter time to clinical recurrence.
{"title":"Evaluación de los factores predictivos tras uretrotomía interna endoscópica para estenosis de uretra bulbar","authors":"A. García Fernández , F. Campos-Juanatey , P. Calleja Hermosa , A. González Fernández , R. Varea Malo , J.L. Gutiérrez Baños","doi":"10.1016/j.acuro.2024.10.007","DOIUrl":"10.1016/j.acuro.2024.10.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Direct vision internal urethrotomy (DVIU) is usually the first treatment offered to patients with bulbar urethral strictures (US). Advances in devices and surgical techniques have contributed to reducing associated complications. Despite the favorable success rate of DVIU, various factors predicting better outcomes have been studied, including patient characteristics, stricture features, and procedural aspects. The main aim of our study is to assess predictive factors for success.</div></div><div><h3>Methods</h3><div>We conducted a retrospective descriptive study of patients who underwent endoscopic internal urethrotomy at our hospital over a 30 year period. Out of 788 DVIU performed, we selected 491 (62.3%) conducted for bulbar US with a minimum follow-up of 12 months. We examined clinical outcomes obtained, and assessed the relationship between different patient characteristics, stricture-related factors and procedural aspects related with clinical success -considered as the avoidance of further interventions for stricture recurrence-. Descriptive statistics were calculated and parametrical and non-parametrical comparative tests were applied. Kaplan-Meier survival analysis was used for evaluating time until recurrence.</div></div><div><h3>Results</h3><div>Mean stricture length was 1.2<!--> <!-->cm (SD 0.5), with only 12 patients presenting with more than 1 US in the bulbar area during DVIU<em>.</em> After a median follow-up of 170 months, 67.4% of patients did not experience clinical recurrence. Severe postoperative complications appear in 0.4% of cases, and need for overnight admission was 4.5%. A positive association was observed between clinical recurrence and a history of prior pelvic radiotherapy (OR 2.8, 95%IC 1.3-22.2), active smoking (OR 2.1, 95% IC 1.6-2.4), infectious etiology of stricture (OR 2.3, 95% IC 1.6-8), history of previous urethroplasty (OR 2.5, 95% IC 1.7-3.2), and higher postoperative urinary catheter sizes (OR 1.8 95% IC 1.1-2.9). Median time until recurrence after the first DVIU was 65 months, after the second was 60 months, after the third was 32 months, and after the fourth was 6 months.</div></div><div><h3>Conclusions</h3><div>Bulbar US could be safely managed with DVIU. The best clinical success is achieved in non-irradiated, non-smoker patients, without prior urethroplasties. The repetition of the procedure is significantly associated with a shorter time to clinical recurrence.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 94-101"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143100802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.11.002
F. Chierigo , G. Mantica , G. Drocchi , F.X. Madec , W. Verla , Ł. Białek , J. Adamowicz , A. Cocci , M. Frankiewicz , J. Klemm , P. Neuville , M. Oszczudłowski , E.J. Redmond , C.M. Rosenbaum , M. Waterloos , M.W. Vetterlein , F. Campos-Juanatey , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos (YAU) - Asociación Europea de Urología (EAU)
Introduction
Anterior urethroplasty is the gold standard for treating complex urethral strictures, primarily focusing on restoring urinary function. However, aesthetic complications, including penile curvature, scarring, and meatal deformities, can impact patient satisfaction, self-image, and quality of life. Despite their significance, cosmetic outcomes are underreported in the literature, affecting patient counseling and surgical planning.
Objective
This scoping review aims to assess the prevalence, types, and contributing factors of cosmetic complications after anterior urethroplasty. A photographic collection of these complications is also presented to aid in clinical education.
Materials and methods
A systematic search of PubMed, Scopus, and Web of Science databases was performed, including studies from 2000 onward that report cosmetic outcomes in male adult patients post-urethroplasty. Following PRISMA guidelines, studies focusing on pediatric cases, case reports with fewer than 10 patients, and those lacking specific cosmetic data were excluded.
Results
Of the 493 studies screened, 97 met the inclusion criteria, with only a minority (8 studies) explicitly discussing cosmetic complications. Reported issues varied widely, including penile curvature, skin tethering, hypertrophic scarring, meatal deformities, and penile shortening, underscoring the diversity of aesthetic challenges in urethral reconstruction.
Conclusion
This review highlights the need for incorporating aesthetic considerations into surgical planning and patient counseling for anterior urethroplasty. Standardized metrics for evaluating cosmetic outcomes could improve patient satisfaction and the quality of care in urethral reconstruction.
{"title":"Complicaciones estéticas de la cirugía de uretra anterior: revisión exploratoria y galería de imágenes","authors":"F. Chierigo , G. Mantica , G. Drocchi , F.X. Madec , W. Verla , Ł. Białek , J. Adamowicz , A. Cocci , M. Frankiewicz , J. Klemm , P. Neuville , M. Oszczudłowski , E.J. Redmond , C.M. Rosenbaum , M. Waterloos , M.W. Vetterlein , F. Campos-Juanatey , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos (YAU) - Asociación Europea de Urología (EAU)","doi":"10.1016/j.acuro.2024.11.002","DOIUrl":"10.1016/j.acuro.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior urethroplasty is the gold standard for treating complex urethral strictures, primarily focusing on restoring urinary function. However, aesthetic complications, including penile curvature, scarring, and meatal deformities, can impact patient satisfaction, self-image, and quality of life. Despite their significance, cosmetic outcomes are underreported in the literature, affecting patient counseling and surgical planning.</div></div><div><h3>Objective</h3><div>This scoping review aims to assess the prevalence, types, and contributing factors of cosmetic complications after anterior urethroplasty. A photographic collection of these complications is also presented to aid in clinical education.</div></div><div><h3>Materials and methods</h3><div>A systematic search of PubMed, Scopus, and Web of Science databases was performed, including studies from 2000 onward that report cosmetic outcomes in male adult patients post-urethroplasty. Following PRISMA guidelines, studies focusing on pediatric cases, case reports with fewer than 10 patients, and those lacking specific cosmetic data were excluded.</div></div><div><h3>Results</h3><div>Of the 493 studies screened, 97 met the inclusion criteria, with only a minority (8 studies) explicitly discussing cosmetic complications. Reported issues varied widely, including penile curvature, skin tethering, hypertrophic scarring, meatal deformities, and penile shortening, underscoring the diversity of aesthetic challenges in urethral reconstruction.</div></div><div><h3>Conclusion</h3><div>This review highlights the need for incorporating aesthetic considerations into surgical planning and patient counseling for anterior urethroplasty. Standardized metrics for evaluating cosmetic outcomes could improve patient satisfaction and the quality of care in urethral reconstruction.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 42-62"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.acuro.2024.12.001
F.X. Madec , P. Neuville , F. Chierigo , J. Adamowicz , Ł. Białek , A. Cocci , M. Frankiewicz , G. Mantica , M. Oszczudłowski , E.J. Redmond , C.M. Rosenbaum , W. Verla , M. Waterloos , F. Campos-Juanatey , J. Klemm , M. Vetterlein , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología
Introduction
Although failures are undesirable, they offer valuable learning opportunities that drive progress through necessary changes. This concept holds particularly true in the history of urethral reconstruction.
Methods
A comprehensive literature review was conducted using PubMed, focusing on the history of the urethral stricture and current trends based on national and international guidelines for urethral stricture management.
Results
Urethral strictures are among the oldest known urological conditions, with initial treatments centred around dilatation. These palliative measures proved disappointing. The advent of reconstructive urology has transformed this pathology into a treatable condition, notably through Excision and Primary Anastomosis (EPA) and one-stage augmentation urethroplasty using buccal grafts.
Conclusion
Urethroplasty is the gold standard treatment for urethral strictures, and ongoing refinements aim to further reduce morbidity.
{"title":"Historia de la cirugía uretral: lecciones aprendidas del pasado","authors":"F.X. Madec , P. Neuville , F. Chierigo , J. Adamowicz , Ł. Białek , A. Cocci , M. Frankiewicz , G. Mantica , M. Oszczudłowski , E.J. Redmond , C.M. Rosenbaum , W. Verla , M. Waterloos , F. Campos-Juanatey , J. Klemm , M. Vetterlein , en representación del Grupo de Trabajo de Urología Reconstructiva y Trauma Urológico de la Sección de Jóvenes Urólogos Académicos - Asociación Europea de Urología","doi":"10.1016/j.acuro.2024.12.001","DOIUrl":"10.1016/j.acuro.2024.12.001","url":null,"abstract":"<div><h3>Introduction</h3><div>Although failures are undesirable, they offer valuable learning opportunities that drive progress through necessary changes. This concept holds particularly true in the history of urethral reconstruction.</div></div><div><h3>Methods</h3><div>A comprehensive literature review was conducted using PubMed, focusing on the history of the urethral stricture and current trends based on national and international guidelines for urethral stricture management.</div></div><div><h3>Results</h3><div>Urethral strictures are among the oldest known urological conditions, with initial treatments centred around dilatation. These palliative measures proved disappointing. The advent of reconstructive urology has transformed this pathology into a treatable condition, notably through Excision and Primary Anastomosis (EPA) and one-stage augmentation urethroplasty using buccal grafts.</div></div><div><h3>Conclusion</h3><div>Urethroplasty is the gold standard treatment for urethral strictures, and ongoing refinements aim to further reduce morbidity.</div></div>","PeriodicalId":7145,"journal":{"name":"Actas urologicas espanolas","volume":"49 1","pages":"Pages 63-71"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143156139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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