Introduction
Materials and methods
Study eligibility criteria
Information sources and search
Study selection
Data collection and data items
Results
Study selection
Study characteristics and results synthesis
Types of procedures and their outcomes
Anastomotic urethroplasty (AU)
Article first author, publication date | No. of patients | Stricture site | Success rate | Failure definition | Mean follow-up (months) | Mean length (cm) |
---|---|---|---|---|---|---|
Ekerhult et al., 2016 [14]a | 20 | Bulbar | 58% bulbar | Need for surgical instrumentation | Bulbar 70 | Bulbar 2 |
Bhagat et al., 2011 [15]a | 40 | Bulbo-membranous/membranous/prostato-membranous | N/D | Maximum urinary flow < 15 ml/s | 60 | 3.7 |
Gupta et al., 2008 [13] | 52 | Posterior | 96.20% | Maximum urinary flow < 10 ml/s | 54 | N/D |
Levine et al., 2014 [16]a | 8 | N/D | 88% | Urethral patency < 16Fr | 49 | 4.9 |
Blaschko et al., 2012 [12]a | 54 | N/D | 88% | Need for surgical intervention or more than one endoscopic treatment | 55 | 4.4 |
Siegel et al., 2015 [17] | 19 | Bulbar | 95% | N/D | 30.1 | 2.1 |
Barbagli et al., 1996 [11]a | 2 | Anterior | 100% | N/D | 57 | N/D |
Morey et al., 1997 [18]a | N/D | Bulbar | 100% | N/D | 12 | N/D |
Wadhwa et al., 1998 [19]a | 14 | Posterior | 78.57% | Need for surgical instrumentation | 4 | 2 |
Joseph et al., 2002 [20]a | N/D | Bulbar/penile | 100% | N/D | 60 | N/D |
Shau et al., 2015 [21]a | N/D | N/D | 80% | Need for any instrumentation | 42 | 2.7 |
Jakse et al., 1996 [22] | 52 | N/D | 90.40% | N/D | 45 | N/D |
Orabi et al., 2008 [23]a | 25 | Posterior | 97% | N/D | N/D | N/D |
Imbeault et al., 2014 [24]a | N/D | N/D | N/D | Radiological abnormality | 25 | N/D |
Cavalcanti et al., 2012 [25]a | 6 | Bulbar | 81.80% | Need for any instrumentation or Qmax < 15 ml/s | 30.8 | 2.8 |
Pardeshi et al., 2016 [26] | 21 | Posterior | 95.20% | Need for instrumentation | N/D | N/D |
Kulkarni et al., 2015 [27] | 15 | Bulbo-membranous | 93.30% | Need for any instrumentation | 18 | 4.2 |
Patrascoiu et al., 2012 [28] | 16 | Posterior | 68.70% | Need for instrumentation or maximum flow < 18 ml/s | 38 | N/D |
Andrich et al., 2011 [29]a | N/D | Bulbar/membranous/prostatic | 100% bulbar, 75% bulbo-prostatic | Radiologically abnormal | 42 | N/D |
Webster et al., 1990 [30]a | 20 | Membranous | N/D | Need for any instrumentation | N/D | N/D |
Shenfeld OZ, 2004 [45] | 8 | Membranous | 100% | Need for any instrumentation | 27 | 2.8 |
Kulkarni SB, 2018 [46]a | 541 | Posterior | 79.13% | N/D | 68 | N/D |
One-stage substitution urethroplasty
Study | N. of patients | Stricture site | Graft type | Graft placement site | Success rate | Failure definition | Mean follow-up length (months) | Mean length (cm) |
---|---|---|---|---|---|---|---|---|
Ekerhult et al., [14]a | 30 | Penile Bulbar | BMG and fasciocutaneous | N/D | Bulbar 58% Penile 18% | Need for surgical intervention | Penile 82 Bulbar 70 | Penile 4 Bulbar 2 |
Rosenbaum et al., [31] | 50 | Penile Bulbar | BMG | Bulbar ventral onlay, penile dorsal inlay | Bulbar 82% Penile 71.4 overall 80.8% | Need for any instrumentation/Qmax rate < 5 ml/s | 25.6 | N/D |
Sevinc et al., [32] | 24 | Penile Bulbar | full thickness circumferential skin graft from arm (n = 20), inner thigh (n = 10) and abdomen (n = 4) | N/D | Arm graft 80%, inner thigh 60%, abdomen 50%, overall 69% | Need for surgical intervention | 23.2 | 7.7 |
Javali et al., [35]a | 21 | Penile Bulbar | BMG | Dorsal onlay Ventral onlay | 85.70% | Need for any instrumentation | 42.4 | 3.18 |
Pfalzgraf et al., [36]a | 33 | Penile Bulbar | BMG and mesh | Bulbar—ventral onlay, penile—ventral onlay and dorsal onlay, dorsal inlay | Bulbar 88.2% Penile 68.8% | Need for any instrumentation | 11.8 | N/D |
Levine et al., [16]a | 26 | Penile Bulbar Membranous | BMG and penile island flap | Onlay | Not discussed | Urethral patency < 16 Fr | 49 | 4.9 |
Tang et al., [37] | 4 | Posterior | BMG | Inlay | 50% | N/D | N/D | N/D |
Blaschko et al., [12]a | 130 | N/D | BMG and faciocutaneous | Onlay tubularised | Not discussed | Need for surgical intervention or more than one endoscopic intervention | 55 | 4.4 |
Barbagli et al., [11]a | 12 | Penile Bulbar | Free patch | N/D | 100% | N/D | 57 | N/D |
Morey et al., [18]a | N/D | Bulbar | BMG, penile skin | BMG unknown, penile circular fasciocutaneous flap | Patch graft 100%, penile circular rasciocutaneous flap = 79% | N/D | 12 | N/D |
Wadhwa et al., [19]a | 1 | posterior | Forearm free flap | N/D | 100% | Need for surgical intervention | 4 | 2 |
Zargooshi et al., [38] | 12 | Hypospadias | Tunica vaginalis | Combined onlay tube | Not discussed | N/D | 30 | N/D |
Xu et al., [39] | 56 | Hypospadias | Lingual, BMG | onlay | 78.60% | Non-functional urethra | 38.1 | 5.6 |
Barbagli et al., [40]a | 21 | Hypospadias | Penile skin/BMG | Penile flaps and dorsal inlay; BMG dorsal inlay/ventral onlay | Penile skin 80%, BMG 82% | Need for any instrumentation | 33.8 | N/D |
Mehrsai et al., [41] | 10 | N/D | BMG | tubed graft | 70% | Radiological abnormality | 22 | 4.9 |
Joseph et al., [20]a | N/D | Penile Bulbar Panurethral | Scrotal skin, post-auricular skin, BMG | N/D | Barbagli patch 100% Orandi flap 75% | N/D | 60 | N/D |
Mehrsai et al., [33] | 34 | Anterior Posterior | BMG | Tubed graft | 76.50% | Need for any instrumentation | 28 | 5.1 |
Shau et al., [21]a | N/D | Bulbar, penile | BMG and skin flaps | Penile—inlay, Bulbar—onlay | 75% skin flaps, BMG unknown | Need for any instrumentation | 42 | 2.7 |
Pandey et al., [34] | 104 | Anterior | BMG | Ventral onlay | 91.40% | N/D | 54 | 8 |
Imbeault et al., [24]a | N/D | N/D | BMG, scrotal skin, lingual graft | Dorsal/ventral | Not discussed | Radiological abnormality | 25 | N/D |
Andrich et al., [25]a | 23 | Bulbar | BMG | Ventral onlay and dorsal onlay, double graft | 81.80% | Need for any instrumentation or Qmax < 15 ml/s | 30.8 | 2.8 |
Andrich et al., [42]a | 40 | N/D | N/D | N/D | N/D | N/D | 96 | N/D |
Grant et al., [43] | 39 | anterior | BMG | Ventral onlay and dorsal onlay | 87.20% | Urethral patency < 14 Fr | N/D | 4 |
Andrich et al., [29]a | N/D | Bulbar Membranous | BMG, scrotal skin | BMG unknown, scrotal inlay | Bulbar BMG 100%, scrotal inlay 60% | Radiological abnormality | 42 | N/D |
Vetterlein et al., [47] | 98 (64 repeat, 34—2° | Bulbar, penile | BMG | Onlay, inlay | Repeat—87.5% 2°—70.8% | N/D | 32 | N/D |
Two-stage substitution urethroplasty
Article first author, year of publication | N. of patients | Stricture site | Graft type | Graft placement | Success rate | Failure definition | Mean follow-up length (months) | Mean length (cm) |
---|---|---|---|---|---|---|---|---|
Ekerhult et al., 2016 [14]a | 5 | Penile | BMG | N/D | 20% | need for surgical intervention | 82 | 4 |
Javali et al., 2016 [35]a | N/D | Panurethral | lingual | Bracka technique | N/D | Need for any instrumentation | 42.4 | 3.18 |
Pfalzgraf et al., 2014 [36]a | N/D | Bulbar Penile | BMG | N/D | N/D | Need for any instrumentation | 11.8 | N/D |
Bhagat et al., 2011 [15]a | N/D | N/D | BMG | Scrotal inlay | N/D | Maximum urinary flow < 15 ml/s | 60 | 3.7 |
Barbagli et al., 1996 [11]a | 3 | Bulbar penile | N/D | N/D | 100% | N/D | 57 | N/D |
Wadhwa et al., 1998 [19]a | 3 | Posterior | N/D | N/D | 100% | Need for surgical intervention | 4 | 2 |
Morrison et al., 2018 [44]a | 27 | Hypospadias | BMG Abdominal skin Post-auricular skin | N/D | 100% for BMG | N/D | 114 | 7 |
Barbagli et al., 2006 [40]a | N/D | Hypospadias | BMG/penile skin | N/D | 50% for penile skin, 82% for BMG | Need for any instrumentation | 33.8 | N/D |
Joseph et al., 2002 [20]a | N/D | Penile Bulbar Panurethral | BMG/post-auricular skin | N/D | 78.9% for BMG, unknown for other | N/D | 60 | N/D |
Calvacanti et al., 2012 [25]a | 4 | Bulbar Penile | BMG | N/D | N/D | Need for instrumentation of maximum urinary flow < 15 ml/s | 30.8 | 2.8 |
Andrich et al., 2005 [42]a | 49 | N/D | N/D | N/D | N/D | N/D | 96 | N/D |
Meeks et al., 2009 [48] | 15 | Hypospadias | BMG, abdominal skin, penile skin, posterior auricular skin | N/D | 86% | Clinical evidence, increased post-void residual volume on USG | 23 | 8 |
Stricture location, surgical procedures and their outcomes
First author and date published | Urethral location | Technique used | Success rate (%) | N. of patients | Mean follow-up (months) |
---|---|---|---|---|---|
Ekelhult et al., 2016 [14] | Penile | One-stage BMG/fasciocutaneous | 18 | n/a | 82 |
Rosenbaum et., 2016 [31] | Penile | One-stage dorsal inlay BMG | 71.40 | n/a | 25.6 |
Two-stage BMG urethroplasty | 20 | n/a | 25.6 | ||
Ekelhult et al., 2016 [14] | Bulbar | Anastomotic urethroplasty | 58 | n/a | 70 |
One-stage BMG | 58 | n/a | 70 | ||
Siegel et al., 2015 [17] | Bulbar | Anastomotic urethroplasty | 95 | 19 | 30.5 |
Rosenbaum et., 2016 [31] | Bulbar | One-stage ventral onlay BMG | 82 | n/a | 25.6 |
Andrich et al., 2011 [29] | Bulbar | Anastomotic urethroplasty | 100 | n/a | 42 |
One-stage bulbar BMG | 100 | n/a | 42 | ||
Morey et al., 1997 [18] | Bulbar | Anastomotic urethroplasty | 100 | n/a | 12 |
One-stage patch graft | 100 | n/a | 12 | ||
One-stage penile circular fasciocutaneous flap | 79 | n/a | 12 | ||
Barbagli et al., 2006 [40] | Hypospadias | Anastomotic urethroplasty | 87 | n/a | 33.8 |
One-stage BMG urethroplasty | 82 | n/a | 33.8 | ||
One-stage penile skin flap | 80 | n/a | 33.8 | ||
Two-stage penile skin | 50 | n/a | 33.8 | ||
Two-stage BMG urethroplasty | 82 | n/a | 33.8 | ||
Meeks et al., 2009 [48] | Hypospadias | Two-stage BMG urethroplasty | 86 | 12 | 23 |
Morrison et al., 2018 [44] | Hypospadias | Two-stage BMG urethroplasty | 100 | n/a | 114 |
Pandey et al., 2017 [34] | Anterior | One-stage BMG ventral onlay | 91.40 | 104 | 54 |
Vetterlein et al., 2018 [47] | Anterior | One-stage BMG urethroplasty | Repeat 87.5 2°—70.8 | Repeat 64 2°—34 | 32 |
Kulkarni et al., 2015 [27] | Bulbo-membranous | Anastomotic urethroplasty | 93.30 | 15 | 18 |
Orabi et al., 2008 [23] | Posterior | Anastomotic urethroplasty | 97 | 51 | n/a |
Pardeshi et al., 2016 [26] | Posterior | Anastomotic urethroplasty | 95.20 | 21 | n/a |
Patrascoiu et al., 2012 [28] | Posterior | Anastomotic urethroplasty | 68.70 | 16 | 38 |
Tang et al., 2011 [37] | Posterior | one-stage BMG inlay | 50 | 4 | n/a |
Wadhwa et al., 1998 [19] | Posterior | Anastomotic urethroplasty | 78.57 | 14 | 4 |
Forearm free flap | 100 | 1 | 4 | ||
Two-stage urethroplasty | 100 | 3 | 4 | ||
Gupta et al., 2008 [13] | Posterior | Anastomotic urethroplasty | 96.20 | 52 | 54 |
Shenfeld et al., 2004 [45] | Posterior | Anastomotic urethroplasty | 100 | 8 | 27 |
Kulkarni et al., 2018 [46] | Posterior | Anastomotic urethroplasty | 79.13 | 541 | 68 |
Andrich et al., 2011 [29] | Bulbo-prostatic | Anastomotic urethroplasty | 75 | n/a | 42 |
Webster et al., 1990 [30] | Bulbo-prostatic | Anastomotic urethroplasty | 95 | 20 | n/a |
Complication rates and follow-up method post-redo-urethroplasty
First author, data of publication | Mean follow (months) | Follow-up method | Mean time to recurrence (months) | Complication rate |
---|---|---|---|---|
Rosenbaum et al., 2016 [31] | 25.6 | Cystourethrography and cystoscopy annually | 13.8 | 16.2% urge incontinence, 10.8% stress incontinence |
Sevinc et al., 2016 [32] | 23.2 | Primary: uroflowmetry every 3 months Secondary: flexible cystoscopy and fluoroscopic imaging | N/D | Abscess, urethrocutaneous fistula |
Javali et al., 2016 [35] | 42.4 | Primary uroflowmetry, post-void residual volume, urine culture and AUA symptom score every 4 months for the first 2 years then every 6 months, secondary: retrograde urethrography and urethroscopy | 24.4 | Wound infection in 9.52%, foot neuralgia in 4.76%, epididymo-orchitis in 4.76%, iatrogenic hypospadias meatus in 4.76% |
Pfalzgraf et al., 2014 [36] | 11.8 | Standardised questionnaire | N/D | Urinary stress incontinence grade I in 15.2% and grade II in 6.1%, altered glans sensitivity in 24.2%, UTI in 36.1% |
Bhagat et al., 2011 [15] | 60 | Uroflowmetry | N/D | Not discussed |
Levine et al., 2014 [16] | 49 | Questionnaire and flexible cystoscopy | N/D | UTIi 10.2%, chordee 14.3% |
Blaschko et al., 2012 [12] | 55 | Uroflowmetry, retrograde urethrography, voiding cystourethrography | 17 | Not discussed |
Siegel et al., 2015 [17] | 30.5 | Uroflowmetry, voiding cystourethrography, questionnaire | N/D | Not discussed |
Barbagli et al., 1996 [11] | 57 | Primary: uroflowmetry, urine culture, secondary: urethrography, voiding cystourethrography if uroflowmetry < 14 cc/s | N/D | Not discussed |
Morey et al., 1997 [18] | 12 | Primary: questionnaires, secondary: retrograde urethrography | N/D | Not discussed |
Wadhwa et al., 1998 [19] | 4 | Voiding cystourethrography | N/D | Not discussed |
Zargooshi et al., 2004 [38] | 30 | Retrograde urethrography, cystourethroscopy, uroflowmetry, urethral biopsy | N/D | Not discussed |
Morrison et al., 2018 [44] | 114 | Patient-reported symptoms, post-void residual volume | 50.2 | Not discussed |
Xu et al., 2016 [39] | 38.1 | Uroflowmetry | N/D | Overall 21.4%: urethrocutaneous fistula and neourethral strictures |
Barbagli et al., 2006 [40] | 33.8 | Primary: uroflowmetry, secondary: retrograde urethrography and urethroscopy if max flow < 12 cc/s | N/D | Not discussed |
Mehrsai et al., 2005 [41] | 22 | Urethrography | 3 | Not discussed |
Joseph et al., 2002 [20] | 60 | Retrograde urethrography, uroflowmetry, symptoms assessment | N/D | 3% fistula, 3% wound infection, 12% post-void dribbling |
Mehrsai et al., 2007 [33] | 28 | Primary: antegrade cystourethrography, questionnaires, urinalysis and culture, secondary: ultrasonography and cystourethrography if max flow < 14 cc/s | 5.5 | Fistula in 5.88%, erectile dysfunction in 2.94%, diverticulum in 2.94%, cheek swelling and perioral numbness in 17.6%, perioral wound infection 1.8%, UTI 23.5% |
Shau et al., 2015 [21] | 42 | Primary: uroflowmetry, post-void residual volume, secondary: retrograde urethrography | N/D | Chronic leg pain 5% |
Jakse et al., 1996 [22] | 45 | Patient-reported symptoms, clinical examination, urinalysis, uroflowmetry, voiding urethrography | N/D | Overall 9%: abscess, haematoma, wound infection, scrotal haematoma, epididymitis, temporary peroneal nerve palsy, incontinence |
Pandey et al., 2017 [34] | 54 | Primary: questionnaire, post-void urine Volume, uroflowmetry, secondary: cystoscopy if max flow < 15 cc/s | N/D | Not discussed |
Imbeault et al., 2014 [24] | 25 | Uroflowmetry, urethrography | 3 | Not discussed |
Calvalcanti et al., 2012 [25] | 30.8 | Primary: uroflowmetry, secondary: urethrography, cystoscopy if max flow < 15 cc/s | N/D | Erectile dysfunction in 15.2%, ejaculatory symptoms in 21.2% |
Kulkarni et al., 2015 [27] | 18 | Primary: uroflowmetry, urine culture, secondary: urethrography and urethroscopy if max flow < 12 cc/s | 2 | Not discussed |
Patrascoiu et al., 2012 [28] | 38 | Clinical examination, post-void residual volume, uroflowmetry, urethrography | N/D | Epididymo-orchitis 18.75%, wound infection 12.5%, perinea haematoma in 12.5%, de novo erectile dysfunction in 6.25% |
Andrich et al., 2011 [29] | 42 | Urethrography | N/D | Not discussed |
Shenfeld et al., 2004 [45] | 27 | Urethrography (after 1 month), flexible retrograde urethroscopy (after year), uroflowmetry, post-void residual volume | N/D | UTI, bladder stones formation decreased erectile function in 12.5%, mild urinary incontinence in 12.5% |
Myers et al., 2012 [49] | 89 | Primary: uroflowmetry, voiding cystourethrography; secondary: fluoroscopic imaging if urinary flow < 15 cc/s | N/D | Not discussed |
Meeks et al., 2009 [48] | 23 | Clinical evidence, post-void residual volume | N/D | Minor voiding symptoms in 21%, fistula in 7%, mild dysuria in 21%, UTI 14%, BMG oral complications in 7% |
Anastomotic urethroplasty | One-stage substitution urethroplasty | Two-stage substitution urethroplasty |
---|---|---|
UTI (36.1%) [36] | Voiding symptoms and mild dysuria (21%) [48] | |
Altered glans sensitivity (24.2%) [36] | UTI (14%) [48] | |
Cheek swelling and perioral numbness (17.6%) [33] | BMG oral complications (7%) |