Felix Campos-Juanatey1, Nadir I Osman2, Tamsin Greenwell3, Francisco E Martins4, Silke Riechardt5, Marjan Waterloos6, Rachel Barratt3, Garson Chan7, Francesco Esperto8, Achilles Ploumidis9, Wesley Verla10, Konstantinos Dimitropoulos11, Nicolaas Lumen10. 1. Urology Department, Marques de Valdecilla University Hospital, Santander, Spain. Electronic address: fcampos@humv.es. 2. Department of Urology, Sheffield Teaching Hospitals, Sheffield, UK. 3. Department of Urology, University College London Hospital, London, UK. 4. Department of Urology, Santa Maria University Hospital, University of Lisbon, Lisbon, Portugal. 5. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 6. Division of Urology, Gent University Hospital, Gent, Belgium; Division of Urology, AZ Maria Middelares, Gent, Belgium. 7. Division of Urology, University of Saskatchewan, Saskatoon, Canada. 8. Department of Urology, Campus Biomedico, University of Rome, Rome, Italy. 9. Department of Urology, Athens Medical Centre, Athens, Greece. 10. Division of Urology, Gent University Hospital, Gent, Belgium. 11. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
Abstract
CONTEXT: Urethral stricture management guidelines are an important tool for guiding evidence-based clinical practice. OBJECTIVE: To present a summary of the 2021 European Association of Urology (EAU) guidelines on diagnosis, classification, perioperative management, and follow-up of male urethral stricture disease. EVIDENCE ACQUISITION: The panel performed a literature review on the topics covering a time frame between 2008 and 2018, and using predefined inclusion and exclusion criteria for the literature. Key papers beyond this time period could be included if panel consensus was reached. A strength rating for each recommendation was added based on a review of the available literature after panel discussion. EVIDENCE SYNTHESIS: Routine diagnostic evaluation encompasses history, patient-reported outcome measures, examination, uroflowmetry, postvoid residual measurement, endoscopy, and urethrography. Ancillary techniques that provide a three-dimensional assessment and may demonstrate associated abnormalities include sonourethrography and magnetic resonance urethrogram, although these are not utilised routinely. The classification of strictures should include stricture location and calibre. Urethral rest after urethral manipulations is advised prior to offering urethroplasty. An assessment for urinary extravasation after urethroplasty is beneficial before catheter removal. The optimal time of catheterisation after urethrotomy is <72 h, but is unclear following urethroplasty and depends on various factors. Patients undergoing urethroplasty should be followed up for at least 1 yr. Objective and subjective outcomes should be assessed after urethral surgeries, including patient satisfaction and sexual function. CONCLUSIONS: Accurate diagnosis and categorisation is important in determining management. Adequate perioperative care and follow-up is essential for achieving successful outcomes. The EAU guidelines provide relevant evidence-based recommendations to optimise patient work-up and follow-up. PATIENT SUMMARY: Urethral strictures have to be assessed adequately before planning treatment. Before surgery, urethral rest and infection prevention are advised. After urethral surgery, x-ray dye tests are advised before removing catheters to ensure that healing has occurred. Routine follow-up is required, including patient-reported outcomes. These guidelines aim to guide doctors in the diagnosis, care, and follow-up of patients with urethral stricture.
CONTEXT: Urethral stricture management guidelines are an important tool for guiding evidence-based clinical practice. OBJECTIVE: To present a summary of the 2021 European Association of Urology (EAU) guidelines on diagnosis, classification, perioperative management, and follow-up of male urethral stricture disease. EVIDENCE ACQUISITION: The panel performed a literature review on the topics covering a time frame between 2008 and 2018, and using predefined inclusion and exclusion criteria for the literature. Key papers beyond this time period could be included if panel consensus was reached. A strength rating for each recommendation was added based on a review of the available literature after panel discussion. EVIDENCE SYNTHESIS: Routine diagnostic evaluation encompasses history, patient-reported outcome measures, examination, uroflowmetry, postvoid residual measurement, endoscopy, and urethrography. Ancillary techniques that provide a three-dimensional assessment and may demonstrate associated abnormalities include sonourethrography and magnetic resonance urethrogram, although these are not utilised routinely. The classification of strictures should include stricture location and calibre. Urethral rest after urethral manipulations is advised prior to offering urethroplasty. An assessment for urinary extravasation after urethroplasty is beneficial before catheter removal. The optimal time of catheterisation after urethrotomy is <72 h, but is unclear following urethroplasty and depends on various factors. Patients undergoing urethroplasty should be followed up for at least 1 yr. Objective and subjective outcomes should be assessed after urethral surgeries, including patient satisfaction and sexual function. CONCLUSIONS: Accurate diagnosis and categorisation is important in determining management. Adequate perioperative care and follow-up is essential for achieving successful outcomes. The EAU guidelines provide relevant evidence-based recommendations to optimise patient work-up and follow-up. PATIENT SUMMARY: Urethral strictures have to be assessed adequately before planning treatment. Before surgery, urethral rest and infection prevention are advised. After urethral surgery, x-ray dye tests are advised before removing catheters to ensure that healing has occurred. Routine follow-up is required, including patient-reported outcomes. These guidelines aim to guide doctors in the diagnosis, care, and follow-up of patients with urethral stricture.
Authors: Felix Campos-Juanatey; Enrique Fes-Ascanio; Jan Adamowicz; Fabio Castiglione; Andrea Cocci; Guglielmo Mantica; Clemens Rosenbaum; Wesley Verla; Malte W Vetterlein; Marjan Waterloos; Luis A Kluth Journal: J Clin Med Date: 2022-04-22 Impact factor: 4.241
Authors: Pankaj M Joshi; Marco Bandini; Sandeep Bafna; Vipin Sharma; Amey Patil; Shreyas Bhadranavar; Christian Yepes; Guido Barbagli; Francesco Montorsi; Sanjay B Kulkarni Journal: Eur Urol Open Sci Date: 2021-11-25