Six-Month Report Assessing the Feasibility and Effectiveness of Amniotic Membrane Injections in Patients With Short, Anterior, Urethral Strictures

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

Journal of Urology

Abstract

MIINTRODUCTION AND OBJECTIVE: Endoscopic urethral stricture treatment has been shown to have high recurrence rates and several adjunct injectable therapeutic agents at the time of endoscopic treatment have been explored. Research supports amniotic membranes(AM) can be used clinically to promote apoptosis of pro-inflammatory cells, prevent differentiation of pro-fibrotic cells, and decrease scar formation. In the context of AM's anti-inflammatory and anti-fibrotic properties, this tissue has generated interest in reconstructive urethral surgery. Thus, we performed the first investigation of the success rate of urethral dilation when combined with micronized AM injection in urethral scar tissue for treatment of urethral stricture. METHODS: Eligible patients were adult males with anterior strictures ≤12Fr in diameter and ≤2 cm in length, International Prostate Symptom Score (IPSS) ≥11 and maximum flowrate<15 ml/s. Reconstituted 100mg micronized AM was injected with a transurethral injection needle in the stricture region at the 5, 7 and 12 o'clock sites during urethral dilation. The primary study end point was anatomical success(≥14Fr by cystoscopy) at 6 months. Key secondary end points were evaluated with the IPSS, Urethral Stricture Surgery e Patient Related Outcome Measure (USS-PROM) and International Index of Erectile Function (IIEF) questionnaires, as well as measurements of flow rate and post void residual. Outcomes were assessed at baseline and at 5days, 14 days, 3 months, and 6 months post-injection. The safety of injections was analyzed. RESULTS: Ten men with a mean age of 52±15 years were included. There were 7 patients with no prior endoscopic treatment of the urethral stricture and 3 patients with one prior dilation. At 6 months,7 of 10 patients (70%) demonstrated recurrence of the urethral stricture on cystoscopy. Improvements in flow rate, PVR, IPSS and USS-PROM symptom scores were noted in 10 of 10 patients at 3 months and 3 of 10patients at 6 months (Table 1). No adverse events observed. CONCLUSIONS: This is the first study evaluating single layer amnion as an adjunct treatment at time of urethral dilation. The urethral stricture rate of recurrence did not improve with the injection of AM despite the hypothesized benefits of anti-fibrotic and anti-inflammatory properties.

Volume

211

Issue

5S

First Page

e518

Comments

American Urological Association Annual Meeting, May 3-6, 2024, San Antonio, TX

DOI

10.1097/01.JU.0001008816.80828.35.09

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