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Clinical Perspectives in Reconstructive Urethral Surgery
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Clinical Perspectives in Reconstructive Urethral Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 20 November 2025 | Viewed by 1549

Special Issue Editor

Dr. Krishnan Venkatesan

E-Mail Website
Guest Editor
Department of Urology, MedStar Washington Hospital Center, Washington, DC 20010, USA
Interests: urinary fistula; urologic reconstruction; peyronie's disease; erectile dysfunction; urethral stricture disease; new surgical techniques

Special Issue Information

Dear Colleagues,

Urethral reconstruction has come a long way from its early days, when it faced outspoken skeptics and outcomes were reported only in small series. Now, urethroplasty is accepted as the gold standard in the management of urethral strictures, and there are urethral stricture guidelines from multiple professional organizations.

As urethral stricture management has become more standardized, new challenges and refinements have been reported. Gender-affirming surgery has led to a new angle in the practice of urologic reconstruction, and complications like urethral strictures and fistulas have been observed. Similarly, new technologies and techniques continue to emerge with the goal of refining urethroplasty and urethral stricture management in general.

This Special Issue will focus on different clinical perspectives on urethral reconstruction, with the hope of highlighting common challenges for reconstructive urologists, including in gender-affirming care and in urethral strictures and bladder neck stenosis in cisgender men. Over the course of this Special Issue, we hope to offer insights and updates that can advance practices and patient care by inspiring each of our readers. 

Dr. Krishnan Venkatesan
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • urethral reconstruction
  • urethroplasty
  • urethral stricture
  • bladder neck stenosis
  • urinary fistula

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Published Papers (2 papers)

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Research

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9 pages, 194 KiB  
Article
A TriNetX Analysis of Hypertrophic Scarring Disorders, Genitourinary Strictures, and Urethroplasty Failure
by Zachary J. Prebay, John Wahlstedt, Afzal Shakir, Eric Wahlstedt, Paul H. Chung and Mihir S. Shah
J. Clin. Med. 2025, 14(2), 302; https://doi.org/10.3390/jcm14020302 - 7 Jan 2025
Viewed by 786
Abstract
Background: Urethral strictures and bladder neck contractures (BNCs) can be significantly morbid for patients and may require intervention for effective urinary drainage. We hypothesized patients with abnormal scarring disorders, such as keloids or hypertrophic scars, are at elevated risks of urethroplasty failure as [...] Read more.
Background: Urethral strictures and bladder neck contractures (BNCs) can be significantly morbid for patients and may require intervention for effective urinary drainage. We hypothesized patients with abnormal scarring disorders, such as keloids or hypertrophic scars, are at elevated risks of urethroplasty failure as well as postprocedural urethral strictures and BNCs. Methods: We queried the TriNetX database to determine the risk of urethroplasty failure for patients with abnormal scarring disorders compared to controls. We also investigated the risk of developing urethral strictures and BNCs for patients undergoing various endourology procedures. Results are reported in terms of risk ratio (RR) with 95% confidence interval (CI). Statistical significance was considered when the CI did not include 1.0. Propensity score matching was performed to limit confounding. Notably, TriNetX rounds values < 10 to 10 for patient anonymity (denoted by *). Results: Urethroplasty patients with scarring pathology needed a second procedure more than twice as often (36.2% vs. <17.2%*, RR = 2.1, 95%CI 1.1–4.1). Following cystoscopy, there was no difference in urethral stricture rates for patients with scarring disorders (2.7% vs. 2.6%, RR = 1.1, 95%CI 0.85–1.3). These patients also showed similar rates of BNCs (7.5% vs. 5.3%, RR = 1.4, 95%CI 0.84–2.3) and urethral strictures (5.9% vs. 5.3%, RR = 1.1, 95%CI 0.68–1.8) after transurethral bladder outlet procedures. Conclusions: Patients with scarring disorders showed much higher urethroplasty failure rates. They experienced similar rates of urethral strictures and BNC formation after endoscopic procedures. These novel findings underscore the importance of recognizing abnormal scarring conditions during preoperative assessments, guiding clinicians in counseling patients and tailoring operative interventions. Full article
(This article belongs to the Special Issue Clinical Perspectives in Reconstructive Urethral Surgery)

Review

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13 pages, 234 KiB  
Review
Antibiotic Prophylaxis After Urethroplasty: A Review of the Literature
by Ellen M. Cahill, Hiren V. Patel, George E. Koch and Joshua Sterling
J. Clin. Med. 2025, 14(11), 3915; https://doi.org/10.3390/jcm14113915 - 2 Jun 2025
Viewed by 453
Abstract
Urethroplasty is a highly effective surgical treatment for urethral stricture disease. While overall complication rates are low, surgical site infections and urinary tract infections (UTIs) represent the most common complications. Due to the prolonged need for catheterization following reconstruction, many urologists place patients [...] Read more.
Urethroplasty is a highly effective surgical treatment for urethral stricture disease. While overall complication rates are low, surgical site infections and urinary tract infections (UTIs) represent the most common complications. Due to the prolonged need for catheterization following reconstruction, many urologists place patients on extended antibiotic prophylaxis postoperatively. However, antibiotic stewardship is important given the risks of antibiotic overuse including opportunistic infections and the emergence of multidrug-resistant organisms. There are currently no established guidelines for the management of antibiotics for patients undergoing urethroplasty, specifically with regard to postoperative prophylaxis through the time of foley catheter removal. In this review, we examine the current literature regarding antibiotic prophylaxis and urethroplasty. Research has shown no clear benefit for extended antibiotic prophylaxis in preventing symptomatic urinary tract infections or stricture recurrence. This is congruent with evidence from other urologic procedures requiring indwelling catheters and/or stents including radical prostatectomy, hypospadias repair, and pyeloplasty. Prospective, randomized trials are needed to further understand the impact of antibiotic prophylaxis on both urethroplasty outcomes and its broader impact on recurrent UTIs and microbial resistance. Full article
(This article belongs to the Special Issue Clinical Perspectives in Reconstructive Urethral Surgery)
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