Nomenclature and treatment of secondary urethral strictures following primary hypospadias repair: weighing up academic p
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LETTER TO THE EDITOR
Nomenclature and treatment of secondary urethral strictures following primary hypospadias repair: weighing up academic principles and clinical pragmatism Malte W. Vetterlein1 · Valentin Zumstein1,2 · Luis A. Kluth3 · Silke Riechardt1 · Roland Dahlem1 · Margit Fisch1 Received: 19 September 2020 / Accepted: 21 September 2020 © The Author(s) 2020
Dear Editor, With great interest we have read the comments by Drs. Shekar and Shivakumar [1] regarding our recent article on buccal mucosal graft urethroplasty (BMGU) for distal urethral strictures [2]. In that regard, we would like to put some points in perspective: First, the authors have expressed some criticism about including patients who had previously undergone treatment for hypospadias. Hence, they claim that our report of a “homogeneous” cohort was untrue. While we concur with the notion that patients with hypospadias-associated strictures do embody a very specific subgroup with distinct disease characteristics, we would like to underline that the homogeneity of our series is warranted by the surgical technique (BMGU using a dorsal inlay) [2]. Contrary to the authors’ opinion, we believe that the end does actually justify the means and that it is important to emphasize the feasibility and durability of one particular surgical technique in such population, especially given the abundance of techniques for the repair of the distal urethra. From a clinical Malte W. Vetterlein and Luis A. Kluth: Member of the Trauma and Reconstructive Urology Working Party of the European Association of Urology (EAU) Young Academic Urologists (YAU). This reply refers to the comment available online at https://doi. org/10.1007/s00345-020-03232-w. * Malte W. Vetterlein [email protected] 1
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2
Department of Urology, Cantonal Medical Center St. Gallen, St. Gallen, Switzerland
3
Department of Urology, University Medical Center Frankfurt, Frankfurt/Main, Germany
perspective, we are confident that it is reasonable to pragmatically approach and consider all patients for the decisionmaking process who present with urethral narrowing of the fossa navicularis or meatus, irrespective of the etiology. In our opinion, the nomenclature is of secondary importance here. Whether the urethral condition is labeled “obliteration”, “narrowing”, “stricture” or “stenosis” does not change the fact that the patient is in need of surgical intervention. Thus, the controversy regarding the correct nomenclature is more or less predominantly academic [3]. However, we absolutely agree that using internationally acknowledged staging systems might facilitate multi-institutional comparisons, first and foremost to evaluate the efficacy of different surgical techniques in discrete stricture cohorts. A great example is the recently developed LSE classification system based on stricture length (L), segment (S), and etiology (E) [4], which particularly accounts for a stricture in the segment of
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