Trauma/Reconstruction/Diversion: New clinical guidelines for stricture

Ramon Virasoro, MDManagement of strictures after BPH surgery and a new clinical guideline for the treatment and diagnosis of male urethral stricture were among the major focuses at the 2016 AUA meeting.  The Trauma/Reconstruction/Diversion discussions were presented by Ramón Virasoro, MD of Eastern Virginia Medical School, Norfolk.

Excision and bulbo-prostatic anastomosis with sphincter sparing for bulbo-membranous urethral strictures after BPH surgery is feasible and safe.

The AUA released a new clinical guideline for the diagnosis and treatment of male urethral stricture.

In patients with urinary diversion for complications of radiation therapy for prostate cancer, 68% had complications at 3 months, and 35% were readmitted. Those with low body mass index developed more severe complications than their heavier counterparts.

In men undergoing surgery for urethral stricture, treatment success rate is the most important treatment attribute, suggesting patients should be strongly counseled about expected success rates of urethroplasty and urethrostomy.

There was only 53% agreement between patients and clinicians in their prioritization of outcomes among men with anterior urethral stricture disease. Of 15 items patients rated by bother, urinary issues predominated.

Continue to the next page for more take-home messages

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• Perineal urethroplasty for the management of urethrovesical anastomotic stenosis after radical prostatectomy yielded excellent urethral patency.

• Analysis of bulbospongiosus-sparing bulbar urethroplasty compared to traditional approach does not seem to have a benefit on ejaculatory function and postvoid dribbling.

• Spina bifida patients who underwent urologic exploration laparotomies had a 91.5% post-op complication rate with an average of 3.0 class 1 complications per person, suggesting they are a unique high-risk population.

• During the Iraq and Afghanistan wars, burns to the perineal region increased risk of death among U.S. service members who suffered combat-related burns. Risk was higher in those with burns to buttocks and genitalia. This reinforces the need for service members to wear protective garments.

More AUA 2016 take home messages

Minimally Invasive Surgery: Study shows huge variance with RALP cost

Infertility/Andrology: Are vasectomy and prostate Ca linked?

Female Urology: Improvements in OAB therapy