Materiały źródłowe

• #1 Urethral Strictures in Males Treatment & Management: Approach Considerations, Surgical Therapy, Open Reconstruction

  https://emedicine.medscape.com/article/450903-treatment

  There is no medical therapy to treat urethral stricture disease; however, urinary tract infections (UTIs) should be adequately treated prior to surgical intervention. Surgical treatment of urethral stricture disease is indicated when the patient has severe voiding symptoms, bladder calculi, increased postvoid residual, urinary tract infection, or when conservative management fails. […] The procedure selection should be discussed thoroughly with the patient in advance, and the discussion should include information on the risks and benefits of the procedure and postoperative care. Risks include, but are not limited to, bleeding, infection, recurrence of stricture, and urethrocutaneous fistula formation. […] Some patients may opt for periodic urethral dilations to manage their stricture disease. The goal is to stretch the scar without producing additional scarring. It may be curative in patients with isolated epithelial strictures (no involvement of corpus spongiosum). Urethral dilation is more likely to be successful in short, first-time, bulbar urethral strictures.

• #2 Treatments of Urethral Stricture | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/urology/urethral-stricture/treatments

  Traditionally, urethral strictures were treated by dilating (enlarging) the urethra with a balloon or an incision. However, most patients had only temporary relief from this treatment. The stricture would typically recur within weeks to months. In addition, these treatment options could cause further injury to the scarred urethra, leading to worsening of the condition. […] Today, surgeons focus on complete removal of the scar tissue. Although the stricture may still recur following this surgery, recurrence rates are low, and overall patient satisfaction is excellent. […] A surgery team can treat almost all strictures close to the bladder by removing the scar and reconnecting the urethra. […] If your stricture is long or closer to your penis tip, you care team needs to use tissue from other parts of your body to make a urethra thats the right size. The team may take these tissues from your penis skin.

• #2 Treatments of Urethral Stricture | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/urology/urethral-stricture/treatments

  They may also take it from the inside of your cheek, which is shown to: […] Be more successful in making part or all the urethra […] Be well tolerated by most patients […] Most patients do not need to stay overnight after this procedure. The incisions are usually small, and most patients report little pain afterward. […] The most bothersome part is often the catheter. However, you need to use the catheter while your urethra is healing. Care teams usually remove catheters after two to three weeks. […] This minimally invasive option can treat short strictures. It uses only local or light anesthesia. […] A urologist will coat (cover) a small balloon with a special medication. The medication is designed to prevent stricture scar tissue from reforming. Then, they will insert the balloon to enlarge the stricture area and put the medication on. […] At experienced centers, stricture surgery has a long-term success rate of more than 95%. For the small number of repairs that are very complex, such as those involving long segments of the urethra, the success rate is about 85% to 90%.

• #3 Urethral Stricture Causes & Treatment | Urology Associates | Denver

  https://www.denverurology.com/urology/urethral-stricture/

  Currently, there are no medications to treat stricture, but procedures like dilation, urethrotomy and urethroplasty can be curative. […] Once the location and severity of the stricture have been identified, the doctor will discuss methods for relieving the blockage and restoring urine flow. Currently there are not any medications available to treat stricture. However, there are a number of effective procedures that can treat stricture disease depending on the location of the scar tissue, how much of the urethra is involved, and what treatments have been tried in the past. […] Dilation and urethrotomy are two less invasive methods of treating simple strictures that are short (1.5 cm in length), located in the bulbar urethra (the part behind the scrotum and inside the body), and when the patient has not had other treatments in the past.

• #4 Urethral stricture – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/urethral-stricture/diagnosis-treatment/drc-20556091

  Treatment might depend on the type of stricture, its size and how bad the symptoms are. Treatments can include: […] Catheterization. Putting a small tube called a catheter into the bladder to drain urine is often the first step for treating urine blockage. Antibiotics treat an infection if there is one. Self-catheterization might be a choice for those diagnosed with a short stricture. […] Widening, called dilation. This starts with a tiny wire put through the urethra and into the bladder. Larger and larger dilators pass over the wire to increase the size of the opening of the urethra little by little. This outpatient procedure may be a choice to treat recurrent urethral strictures. […] Urethroplasty. This involves surgically removing the narrowed section of the urethra or making it larger. The procedure might also involve rebuilding tissues around the urethra. Tissues from other areas of the body, such as the skin or mouth, may be used as a graft during the process. The chance of urethral stricture coming back after a urethroplasty is low.

• #5 Urethral Stricture Disease Treatment – Idaho Urologic Institute

  https://idurology.com/urologic-care/urethral-stricture-disease/

  Once the bladder is empty, you remove the catheter and repeat at regular intervals during the day. Some people may need to complete this method four to six times a day or every few hours depending on how fast the bladder fills up. […] Intermittent self-catheterization can keep the scarred area of the urethra from narrowing, but this method can be painful or time-consuming and requires a constant supply of catheters. Additionally, inserting catheters too often or having them in too long can risk introducing bacteria into the body and lead to infection, scarring, UTIs, spasms or perforations. […] Urethral Stricture Dilation […] Standard dilation for urethral stricture is another common type of treatment. This outpatient procedure involves general or local anesthesia and is performed by a urologist. The treatment involves stretching the narrow stricture tissue out using rod dilators that increase in diameter or a dilation balloon inserted by a catheter. While this solution is a non-surgical treatment option for urethral stricture disease, some patients may find it’s only short-term.

• #6 Urethral Stricture Treatment Arizona – East Valley Urology Center of Arizona

  https://evucenter.com/urethral-stricture-treatment-arizona/

  Once the bladder is empty, you remove the catheter and repeat at regular intervals during the day. Some people may need to complete this method four to six times a day or every few hours depending on how fast the bladder fills up. […] Intermittent self-catheterization can keep the scarred area of the urethra from narrowing, but this method can be painful or time-consuming and requires a constant supply of catheters. Additionally, inserting catheters too often or having them in too long can risk introducing bacteria into the body and lead to infection, scarring, UTIs, spasms or perforations. […] Urethral Stricture Dilation […] Standard dilation for urethral stricture is another common type of treatment. This outpatient procedure involves general or local anesthesia and is performed by a urologist. The treatment involves stretching the narrow stricture tissue out using rod dilators that increase in diameter or a dilation balloon inserted by a catheter. While this solution is a non-surgical treatment option for urethral stricture disease, some patients may find its only short-term.

• #7 Urethral/ureteral stricture, La Crosse – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/locations/la-crosse/services-and-treatments/urology/urologic-conditions-and-treatments/urethral-and-ureteral-strictures

  Endoscopic urethrotomy For this procedure, your doctor inserts a thin optical device (cystoscope) into your urethra, then inserts instruments through the cystoscope to remove the stricture or vaporize it with a laser. This surgical procedure offers a faster recovery, minimal scarring and less risk of infection, although recurrence is possible. […] Dilation Your doctor inserts a tiny wire through the urethra and into the bladder. Progressively larger dilators pass over the wire to gradually increase the size of the urethral opening. This outpatient procedure may be an option for recurrent urethral strictures. […] Catheterization Inserting a small tube (catheter) into your bladder to drain urine is the usual first step for treating urine blockage. Your doctor might also recommend antibiotics to treat an infection, if one is present. Self-catheterization might be an option if you’re diagnosed with a short stricture.

• #8 Urethral Strictures

  https://dcurology.net/common-problems/urethral-strictures.php

  Another urologic condition we see and treat regularly is urethral strictures. […] The simplest treatment is dilation of the stricture. […] Our preferred approach for the initial presentation of a urethral stricture is to perform a minor procedure, under anesthesia, called a direct vision internal urethrotomy (DVIU). […] If a stricture does recur, more aggressive solutions will be offered. […] A urethroplasty is a surgical repair of a stricture whereby the affected area is dissected and either fully excised with the good ends brought together with sutures (an anastomotic urethroplasty), or incised and the gap in the tubular urethra filled with tissue. […] Depending on the location and severity of the stricture a urethroplasty can afford a 93% success rate or better with no recurrence. […] Treatments: Dilation, Internal Urethrotomy (DVIU), Urethroplasty. […] Risk of Recurrence: Dilation 80-90%, Internal Urethrotomy (DVIU) 40-50%, Urethroplasty 5-10%.

• #9 Urethral stricture – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/urethral-stricture/diagnosis-treatment/drc-20556091

  Endoscopic urethrotomy. This procedure uses a thin, tubelike tool that has a lens, called a cystoscope. The cystoscope goes into the urethra. Then a tool is put through the cystoscope to remove the stricture or treat it with a laser. This surgical procedure has a faster recovery than do some other procedures. It doesn’t leave much scarring, and the risk of infection is low. However, urethral stricture can come back after this procedure. […] Implanted stent or long-term catheter. This treatment might be for people with a severe stricture who don’t want surgery. A tube, called a stent, is put into the urethra to keep it open, Or a permanent catheter is put in to drain the bladder. These procedures have a risk of bladder irritation, discomfort and urinary tract infections. They also need to be watched closely. Urethral stents are rarely used.

• #10 Urethral Stricture Disease Treatment – Idaho Urologic Institute

  https://idurology.com/urologic-care/urethral-stricture-disease/

  Internal urethrotomy for urethral stricture uses a special scope that moves along the urethra to locate the stricture. This treatment is often an outpatient surgery that involves cutting the stricture to create a gap using a laser or knife blade at the end of the cystoscope. […] Once the stricture is cut open, the bladder is emptied through a catheter and filled up again with irrigation fluid, which is drained afterward. To let the opened stricture heal, the surgeon will often place a new catheter to hold the gap open and remain in place for a certain length of time depending on the length or severity of the stricture. […] Short-term (less than six months) success rates for internal urethrotomy are about 70%-80% and will often increase after the five-year mark if there’s no recurrence.

• #11 Urethral Stricture Treatment Arizona – East Valley Urology Center of Arizona

  https://evucenter.com/urethral-stricture-treatment-arizona/

  Once the stricture is cut open, the bladder is emptied through a catheter and filled up again with irrigation fluid, which is drained afterward. To let the opened stricture heal, the surgeon will often place a new catheter to hold the gap open and remain in place for a certain length of time depending on the length or severity of the stricture. […] Short-term (less than six months) success rates for internal urethrotomy are about 70%-80% and will often increase after the five-year mark if theres no recurrence. […] Urethroplasty […] Urethroplasty is an inpatient surgical treatment option with an average stay of about 2.5 days. Urethroplasty for urethral stricture is a reconstructive procedure that consists of two main types: anastomotic urethroplasty and substitution urethroplasty.

• #12 Urethral Stricture Treatment – Laborie

  https://www.laborie.com/patients/conditions/optilume-for-urethral-stricture-treatment/

  If you or a loved one frequently has trouble urinating, blood in the urine or other uncomfortable symptoms, you may be affected by urethral stricture disease. […] Researching treatment options may seem a bit daunting, especially if you’ve never sought medical care for this issue before. […] Below, we’ll discuss some treatment options for urethral strictures as well as some benefits and considerations of each. […] Intermittent self-catheterization (ISC) for urethral stricture allows patients to empty their bladders if they have difficulty or discomfort when urinating. […] Standard dilation for urethral stricture is another common type of treatment. […] Optilume is the world’s first Drug Coated Balloon approved by the FDA to treat patients with Urethral Strictures. […] Internal urethrotomy for urethral stricture uses a special scope that moves along the urethra to locate the stricture. […] Urethroplasty for urethral stricture is a reconstructive procedure that consists of two main types: anastomotic urethroplasty and substitution urethroplasty.

• #13 Urethral Stricture Disease Treatment – Idaho Urologic Institute

  https://idurology.com/urologic-care/urethral-stricture-disease/

  During the Optilume procedure, The Optilume device expands the scar tissue surrounding the urethral stricture creating a dilation and micro-fissures across the affected area. This allows the drug, paclitaxel, to be delivered directly to the stricture. This combined technique results in limiting scar tissue generation and helps prevent future stricture recurrence. […] Optilume® is proven to provide superior results compared to the standard of care for endoscopic management. The ROBUST III Randomized Controlled Clinical Trial showed that 83% of patients remained free from re-treatments for their urethral stricture 1 year after their Optilume procedure. A doctor can consult with you to determine your best treatment option. Contact us to find a full list of Optilume® providers. […] Urethrotomy

• #14 Urethral Strictures in Males Treatment & Management: Approach Considerations, Surgical Therapy, Open Reconstruction

  https://emedicine.medscape.com/article/450903-treatment

  A systematic review and meta-analysis supported the use of balloon dilation as a possible intermediate step before urethroplasty, and as an alternative to simple dilation and direct visual internal urethrotomy (DVIU). […] American Urological Association guidelines conditionally recommend the use of drug-coated balloons for treatment of recurrent bulbar urethral strictures 3 cm in length. […] Internal urethrotomy involves incising the stricture transurethrally using endoscopic equipment. The incision allows for release of scar tissue. […] Complications include recurrence of stricture, which is the most common complication; bleeding; and extravasation of irrigation fluid into perispongial tissues, thus increasing the fibrotic response. […] Primary repair (excision and primary anastomosis [EPA]) involves complete excision of the fibrotic urethral segment with reanastomosis.

• #15 Urethral Stricture Treatment Hospital & Surgery Specialist in India – RG Hospital

  https://www.rghospitals.com/speciality/urology/urethral-stricture-treatment

  Urethroplasty is the gold standard for treating urethral stricture, especially in severe or recurrent cases. This surgical procedure involves removing the scar tissue causing the stricture and then reconstructing the Urethra. There are different types of Urethroplasty, including Anastomotic Urethroplasty, where the healthy ends of the urethra are sewn together, and Buccal mucosa graft Urethroplasty, where tissue from the inside of the cheek is used to reconstruct the urethra. Urethroplasty offers long-term relief and is highly effective. […] In cases where surgical repair may not be an option or if a patient is not a candidate for a major surgery, Urethral Stents may be placed to keep the urethra open. A stent is a small tube inserted into the Urethra to prevent it from collapsing and allow urine to pass through. While stents can help manage symptoms temporarily, they often require regular monitoring and replacement.

• #16 Urethral Stricture Disease | University of Michigan Health

  https://www.uofmhealth.org/conditions-treatments/adult-urology/urethral-stricture-disease

  A knife blade or laser at the end of the cystoscope is used to cut the stricture and create a gap. A catheter may be placed into the urethra to hold the gap open and let it heal. […] Many reconstructive procedures have been used to treat strictures, and some involve 1 or 2 operations. In all cases, the choice of repair is based on the location and length of the stricture and how serious it is. […] The 2 main types are anastomotic urethroplasty and substitution urethroplasty. […] Anastomotic Urethroplasty: This method is usually reserved for short urethral strictures. […] Substitution Urethroplasty: When the stricture is long, tissue can be transferred to replace the section that had the stricture. […] Overall the success rates are very good. […] After Treatment: Because urethral strictures can come back after surgery, you should be followed by a urologist. […] Sometimes the doctor performs urethroscopy to check the repair. In some patients, the stricture may return but may not need additional treatment. But if it causes obstruction, it can be treated with urethrotomy or dilation. Repeat open surgery may be needed for serious strictures that come back.

• #17 Urethral Stricture Treatment Arizona – East Valley Urology Center of Arizona

  https://evucenter.com/urethral-stricture-treatment-arizona/

  1. Anastomotic Urethroplasty […] Usually reserved for short, minor urethral strictures, this method involves cutting between the scrotum and rectum and reconnecting the urethra to remove the stricture. This surgery can be either inpatient or outpatient and requires a catheter for up to three weeks and an X-ray image after removal to ensure the repair is healed. […] 2. Substitution Urethroplasty […] For longer or more severe strictures, this surgery involves transferring tissue to replace the area where the stricture was. This procedure may be inpatient or outpatient and can consist of repairs in several different stages, including: […] Free graft: This process involves enlarging part of the urethra using the patients own tissue. This inpatient procedure may require skin from another part of the body and a two to three-week use of a catheter after.

• #18 Management of Anterior Urethral Strictures – European Medical Journal

  https://www.emjreviews.com/urology/article/management-of-anterior-urethral-strictures/

  Urethral dilatation dynamically extends the urethral lumen by means of dilators that are calibrated in accordance with the French system, in which the dilator size correlates with the urethral circumference in millimetres. […] During urethrotomy, an incision is made through the stricture to the healthy underlying tissue to increase luminal calibre. […] Urethroplasty is considered the ideal treatment of anterior urethral strictures. […] The types of urethroplasty available include excision and primary anastomosis (EPA), augmentation and substitution with a dorsal or ventral onlay graft, or a flap. […] The long-term success of EPA for short (2 cm) bulbar urethral strictures is around 90-95%, therefore it is recommended for such strictures regardless of aetiology or prior treatment. […] For strictures 2 cm in length, the anastomosis is augmented using a buccal mucosa graft (BMG) placed ventrally or dorsally, with a tissue flap if necessary.

• #19 Urethral Stricture Treatment Arizona – East Valley Urology Center of Arizona

  https://evucenter.com/urethral-stricture-treatment-arizona/

  Skin flap: This option involves rotating flaps of skin from the genitalia to create a new section of the urethra for a severe stricture. This is an inpatient procedure that also requires catheter use for a few weeks. […] Staged: When local tissue cannot work for a free graft or skin flap, this option involves securing a graft to the opened urethra and letting it mature and heal over time until it becomes soft and flexible. […] While these surgeries often produce long-lasting results, potential complications and side effects include erectile dysfunction and penile curvature.

• #20 Urethral Structure | Reconstructive Urology | IU School of Medicine

  https://medicine.iu.edu/urology/expertise/reconstructive-urology/clinical-care/urethral-stricture

  Anastamotic urethroplasty is employed for short strictures of the bulbar urethra. A section of scarred urethra is removed and the two ends are sewn back together. The success rate is 90-95 percent. […] Substitution graft urethoplasty is used for longer strictures greater than two centimeters and penile urethra scar tissue. A piece of tissue from the mouth (buccal mucosa) is harvested by an oral surgeon. This mouth graft is used to reconstruct the urethra by patching the damaged area and increasing the tube size. Long-term success is approximately 80-85 percent. […] Staged urethoplasty is a rarely technique used for the worst strictures. It is employed for urethras that are damaged for almost the entire length. This option involves multiple staged surgeries before the urethra is entirely repaired.

• #21 Urethral Strictures in Males Treatment & Management: Approach Considerations, Surgical Therapy, Open Reconstruction

  https://emedicine.medscape.com/article/450903-treatment

  Buccal mucosa offers several advantages as grafting source. This tissue is adapted to a moist environment and is resistant to infection and trauma. […] Tissue engineering of grafts for urethral strictures offers the potential benefit of eliminating the need for autologous tissue; this would be particularly useful in patients with long strictures, who would otherwise require harvesting of lengthy mucosal grafts. […] Postoperative urinary tract infection and wound infections are rare complications of surgery to repair urethral strictures.

• #22 Innovative approach to surgical urethral stricture management – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/urology/news/innovative-approach-to-surgical-urethral-stricture-management/mac-20573543

  Mayo Clinic’s reconstructive urology team, which includes Katie T. Anderson, M.D., Boyd R. Viers, M.D., and Nick Warner, M.D., is setting a new standard in the management of male and female urethral strictures. […] This team at Mayo Clinic is the only one in the U.S. that offers a comprehensive range of definitive treatment options that are tailored to the patient, including transluminal urethral surgery, known as TRAMUS, open surgery and robotic repairs. „We have the skill set amongst the three of us to offer each patient the best possible surgical option,” says Dr. Anderson. […] The specialized transluminal technique to repair urethral strictures allows for definitive reconstruction through the natural urethral opening without incision. […] Mayo Clinic is the first institution in the U.S. to offer specialized transluminal techniques to treat urethral strictures in both men and women. The urethral stricture is opened in a transluminal approach. From here, definitive reconstruction occurs via the primary reapproximation of the healthy urethra, or a graft is deployed and fixed from the mouth across the incised area. This is all done through the natural urethral opening without the need for an external incision.

• #23 Innovative approach to surgical urethral stricture management – Mayo Clinic

  https://www.mayoclinic.org/medical-professionals/urology/news/innovative-approach-to-surgical-urethral-stricture-management/mac-20573543

  The benefit of this approach is that it is a much more precise and efficient operation. Without extensive incisions and dissection of the surrounding structures, the risks of the surgery are reduced, including bleeding, sexual dysfunction and infections, and there is a faster recovery time. […] In some situations, the TRAMUS approach is not appropriate, and an open repair may be required. Alternatively, some patients may be good candidates for drug-coated balloon dilation. Lastly, advanced robotic reconstruction solutions are possible, as in cases of posterior urethral trauma from motor vehicle accidents or due to prostate cancer therapy. […] Each team member has fellowship training, bringing unparalleled expertise to the evaluation and treatment of urethral strictures. The team’s collaborative approach includes detailed case conferences, where every stricture is evaluated to determine the most effective treatment strategy based on its location and etiology. This personalized care considers the underlying cause of the stricture, whether it stems from infection, trauma, radiation therapy or complications of surgical prostate cancer treatment.

• #24 Urethral stricture – UF Health

  https://ufhealth.org/conditions-and-treatments/urethral-stricture

  A surgery called an open urethroplasty may be done for longer strictures. This surgery involves removing the diseased area. The urethra is then rebuilt. The results vary, depending on the size and location of the stricture, the number of treatments you have had, and the surgeon’s experience. […] In acute cases when you cannot pass urine, a suprapubic catheter may be placed. This is an emergency treatment. This allows the bladder to drain through the abdomen. […] There are currently no drug treatments for this disease. If no other treatments work, a urinary diversion called an appendicovesicostomy (Mitrofanoff procedure) or another type of surgery may be done. This lets you drain your bladder through the wall of the abdomen using a catheter or a stoma bag. […] The outcome is often excellent with treatment. Sometimes, treatment needs to be repeated to remove scar tissue. […] A urethral stricture may totally block urine flow. This can cause sudden urinary retention. This condition must be treated quickly. Long-term blockage can lead to permanent bladder or kidney damage.

• #25 Pharmacotherapy of urethral stricture

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10846832/

  Urethral stricture is characterized by the chronic formation of fibrous tissue, leading to the narrowing of the urethral lumen. […] Despite the availability of various endoscopic treatments, the recurrence of urethral strictures remains a common challenge. […] Postsurgery pharmacotherapy targeting tissue fibrosis is a promising option for reducing recurrence rates. […] Although drugs cannot replace surgery, they can be used as adjuvant therapies to improve outcomes. […] In recent years, advances have been made in using various drugs for treating urethral stricture globally. […] Therefore, summarizing the progress of pharmacological treatment of urethral stricture can help to develop an effective prevention and treatment plan, which is important for the treatment and prognosis of this patient population, improving their quality of life and reducing the economic burden.

• #26 Pharmacotherapy of urethral stricture

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10846832/

  Studies have corroborated the potential role of many Wnt inhibitors in tissue fibrosis. […] Current evidence suggests that triamcinolone (TA) can inhibit scar fibroblast proliferation and enhance collagen degradation in the urethra. […] The recurrence of urethral stricture after IU is commonly found during clinical practice. […] These studies substantiate that MMC is an antifibrotic agent that can prevent scar formation and reduce fibroblast proliferation, which are the main causes of stricture recurrence. […] Overall, these approaches have shown some therapeutic efficacy and warrant further study. […] Medication, as an adjuvant treatment, plays a crucial role in urethral stricture. […] The primary role of pharmacotherapy in urethral stricture is to modulate the pathophysiological mechanisms of urethral stricture, thereby reducing the recurrence rate. […] Rational pharmacotherapy may revolutionize urethral stricture disease; therefore, future prospective studies are warranted to obtain further evidence and refine the current management of urethral stricture disease.

• #27 The use of local therapy in preventing urethral strictures: A systematic review | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258256

  Urethral stricture disease is a common problem amongst men in Western countries often leading to a decreased quality of life. Current endoscopic treatment procedure shows an unsatisfying stricture recurrence rate which could be improved by addition of local therapies. […] To provide an overview of both preclinical and clinical studies in order to investigate current level of evidence on the addition of local therapy to improve urethral stricture recurrence rates after endoscopic procedures. […] Regarding clinical studies, mitomycin-C and hyaluronic acid and carboxymethylcellulose showed positive effects on urethral stricture recurrence rates with low to intermediate risk of bias across studies. However, the positive clinical effects of mitomycin-C and steroids seemed to decrease in studies with a longer follow-up time.

• #28 Pharmacotherapy of urethral stricture

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10846832/

  To find drugs currently used in the treatment of urethral stricture, we conducted a literature search using the formula (urethral stricture [Title/Abstract]) OR (urethrostenosis [Title/Abstract]) AND (Drug [All Fields]). […] The antifibrotic effect of ACEI is primarily mediated by inhibition of TGF-1. […] Importantly, a phase II clinical trial achieved satisfactory results with limited side effects using an intraurethral injection of captopril gel after DVIU surgery. […] A comparative study by Chong et al. concluded that rapamycin could inhibit experimentally induced urethral stricture formation in rabbits and that this physiological effect may be mediated by inhibiting urothelial fibroblast proliferation and/or a reduction in collagen accumulation. […] The mechanism may be related to the role of rapamycin in inhibiting TGF-1 and Smad3 expression and promoting MMP1 expression in urethral tissue.

• #29 Urethral stricture – Wikipedia

  https://en.wikipedia.org/wiki/Urethral_stricture

  Initial treatment usually involves urethral dilation (widening the tube) or urethrotomy, where the stricture is cut away with a cystoscope. […] Urethral dilation and other endoscopic approaches such as direct vision internal urethrotomy (DVIU), laser urethrotomy, and self intermittent dilation are the most commonly used treatments for urethral stricture. However, these approaches are associated with low success rates and may worsen the stricture, making future attempts to surgically repair the urethra more difficult. […] A Cochrane review found that performing intermittent self-dilatation may confer a reduced risk of recurrent urethral stricture after endoscopic treatment, but the evidence is weak. […] Urethroplasty refers to any open reconstruction of the urethra. Success rates range from 85% to 95% and depend on a variety of clinical factors, such as stricture as the cause, length, location, and caliber.

• #30 Urethral/ureteral stricture, La Crosse – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/locations/la-crosse/services-and-treatments/urology/urologic-conditions-and-treatments/urethral-and-ureteral-strictures

  Generally, whenever urethroplasty is possible for treating urethral stricture, doctors prefer that procedure over other surgical treatments. The conventional wisdom is that performing urethroplasty early during the course of treatment spares you from needing multiple endoscopic urethrotomies, if urethral stricture recurs.

• #31 EAU Guidelines on Urethral Strictures – Uroweb

  https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-females

  The symptoms of female urethral strictures are non-specific and therefore generally non-diagnostic. Female urethral stricture presents with mixed filling and voiding symptoms with frequency in 63%, urgency in 55%, incomplete emptying in 36%, poor flow in 32%, urinary incontinence in 31% (stress, urge or mixed), strain void in 21.5%, UTI in 20.5%, nocturia in 20.5%, and dysuria in 20%. It very rarely presents with urethral pain (2.7%), terminal dribble (2%), haematuria (1.6%) or renal failure (0.5%) (see supplementary Table S7.1). […] Several minimally invasive treatments have been reported; these include urethrotomy, dilatation, meatotomy and meatoplasty. Meatotomy and meatoplasty are essentially the same procedure in the female urethra and the term meatoplasty will be used, in the context of female urethral strictures, throughout this document.

• #32 EAU Guidelines on Urethral Strictures – Uroweb

  https://uroweb.org/guidelines/urethral-strictures/chapter/disease-management-in-females

  If utilised, urethrotomy in the female urethra involves incisions at three, nine and occasionally twelve oclock. […] With this treatment, the urethra is dilated to between 24 Fr and 41 Fr. […] Due to the low complication rate, the minimally invasive nature of the technique and the reasonable success rate, it is acceptable to start with urethral dilation as a first-line treatment for an uncomplicated FUS. If the stricture recurs then repeat urethral dilatation is unlikely to be curative. […] For short meatal strictures, meatoplasty is the first-line treatment option. […] Twenty-five papers report the outcomes of urethroplasty for FUS disease in 253 patients in total after the scope search of the Panel. […] At a mean/median follow-up time of 8.5-24.65 months (range 6-36) following vaginal graft urethroplasty 59 (82% range 73-94%) of patients had no recurrent stricture. […] Urethroplasty provides patency rates of 62.5-100%. Ventral-onlay BMG and DOBMG reported patency rates are 92-100% and 62.5-100%, respectively. […] Treat meatal strictures by meatotomy/meatoplasty.

• #33 Urethral Stricture in Men: Symptoms, Causes, and Treatment

  https://www.webmd.com/digestive-disorders/what-to-know-about-urethral-stricture

  Urethral stricture treatments involve minor procedures, open surgery, or treating underlying conditions like urinary tract infections or an enlarged prostate. There are no medications to treat urethral strictures. […] Some common procedures include: […] Urethra dilation, a procedure to widen the urethra […] Urethrotomy, where they use a laser and scope to remove scar tissue […] Urethral reconstruction, an open surgery to cut out the scarring and then reconnect the urethra […] Urethroplasty, a surgery to rebuild the urethra with tissue from the penis or scrotum. […] Urethral stricture treatment generally helps, but the stricture can come back, which means you’ll need treatment again. If you’re having trouble urinating or other symptoms, make sure you talk to your doctor.

• #34 Urethral stricture – Wikipedia

  https://en.wikipedia.org/wiki/Urethral_stricture

  When in acute urinary retention, treatment of the urethral stricture or diversion is an emergency. Options include: Urethral dilatation and catheter placement. This can be performed in the Emergency Department, a practitioner’s office or an operating room. The advantage of this approach is that the urethra may remain patent for a period of time after the dilation, though long-term success rates are low. […] Following urethroplasty, patients should be monitored for a minimum of 1 year, since the vast majority of recurrences occur within 1 year. […] Because of the high rate of recurrence following dilation and other endoscopic approaches, the provider must maintain a high index of suspicion for recurrence when the patient presents with obstructive voiding symptoms or urinary tract infection.

• #35 Management of Anterior Urethral Strictures – European Medical Journal

  https://www.emjreviews.com/urology/article/management-of-anterior-urethral-strictures/

  In substitution urethroplasty, the strictured portion of the urethra is replaced with grafts or flaps. […] However, in the case of LS related strictures with autoimmune aetiology, BMG is the recommended graft because surgical reconstruction using genital skin tends to end in failure. […] Complications of urethroplasty include post-void dribbling, diverticulum/pouch, urinary tract infection, chordee, urethrocutaneous fistula, impotence, and reoccurrence of strictures. […] Though urethroplasty has a 95% success rate, many urologists have little experience performing this procedure, resulting in their preference for repeated endoscopic procedures in spite of unsatisfactory results. […] Tissue engineering has demonstrated promise in developing tissue substitutes that can restore urethral function in the form of acellular matrices as well as cell-seeded tissue engineered constructs. […] All the above studies demonstrate the feasibility and efficacy of using tissue engineering based approaches for the treatment of complex urethral strictures.

• #36 How to manage pain associated with urethral stricture |Regrow

  https://www.regrow.in/blogs/manage-pain-associated-with-urethral-stricture

  Epithelial cell therapy is an innovative new treatment for urethral stricture that involves injecting healthy cells into the urethra to promote healing. This therapy is still in the early stages of development, but early studies have shown promise in treating urethral stricture and reducing pain. […] While there is no cure for urethral stricture, there are treatments available that can help to manage the pain and improve quality of life. Epithelial cell therapy is a new treatment option that is showing promise in treating urethral stricture and reducing pain. […] If you are living with urethral stricture, talk to your doctor about whether epithelial cell therapy may be right for you. This innovative new treatment option may help you find relief from your symptoms and improve your quality of life.

• #37 The use of local therapy in preventing urethral strictures: A systematic review | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258256

  Although local adjuvant use of mitomycin-C or hyaluronic acid and carboxymethylcellulose may carry clinical potential to improve urethral structure recurrence rates after endoscopic procedures, we believe that a large, well-designed RCT with a yearlong follow-up time is necessary to identify the true clinical value. […] This systematic review shows that local adjuvant therapeutics may have a positive effect on current unsatisfying US recurrence rates after endoscopic procedures. Although MMC and HA/CMC seem to carry the highest clinical potential, clinical effects may decrease over time which underlines the need for a large, well-designed RCT with a yearlong follow-up before considering clinical implementation.

Zobacz więcej