Early Catheter Removal on Seventh Postoperative Day Following Ventral Inlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: A Pilot Study

Early Catheter Removal on Seventh Postoperative Day Following Ventral Inlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: A Pilot Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Early Catheter Removal on Seventh Postoperative Day Following Ventral Inlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: A Pilot Study Vivek Tarigopula, Swarnendu Mandal, Kirti Singh, Mithilesh Yadav, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6569951/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jul, 2025 Read the published version in International Urology and Nephrology → Version 1 posted You are reading this latest preprint version Abstract Introduction : While the ideal catheterisation time following augmentation urethroplasty is unknown, there is emerging evidence of comparable long-term results of decreasing it in male urethroplasties. This has not been studied in females. Prolonged catheterisation leads to increased patient discomfort and catheter-related urinary-tract-infections (CAUTI). We attempted to study the feasibility and efficacy of catheter removal on the seventh postoperative day following ventral inlay buccal mucosal graft urethroplasty (VI BMGU) for female urethral stricture (FUS). Methods : This was a single-centre, prospective observational pilot study conducted between May 2023 and July 2024. [Ethics committee approval: T/IM-NF/Uro/22/177; Clinical Trials Registry of India: CTRI/2023/05/066957]. Consenting females undergoing VI BMGU for FUS were included. The primary objective was success rate at a minimum follow-up of 6 months, while secondary objectives were a comparison of the American-Urological-Association (AUA) symptom score, maximum urinary flow rate (Qmax) and Postvoid Residual volume (PVR) and CAUTI rate per 1000 urinary catheter days. Results : Twenty three patients were recruited, and 22 were included in the final analysis with a median follow up of 12 (9-15) months. There were three recurrences, with an estimated success rate of 84% at 18 months. Compared to preoperative parameters, there were significant improvements in median AUA scores, Qmax and PVR. The CAUTI rate per 1000 urinary catheter days was calculated at 12.42. Conclusion : Catheter removal on day seven following VI BMGU is a safe and effective strategy offering durable outcomes while reducing the risks associated with prolonged catheterisation. Larger randomised studies are warranted with a comparison of different surgical techniques. Figures Figure 1 Introduction There has been a trend towards decreasing catheterisation time following male urethroplasties. There are multiple reports of comparable results despite of decreasing catheter duration.( 1 – 3 ) This has not been explored in the realm of female urethroplasties. Female Urethral Stricture (FUS) is one of the least understood and studied conditions in the field of Urology. It’s true incidence remains unclear, with some estimates suggesting it accounts for less than 10% of females with bladder outlet obstruction.( 4 ) While diagnosis of this entity is not as straightforward as in male patients, the ideal management strategy is debated the world over, adding to the enigma. With emerging evidence on urethral reconstruction techniques, urethral dilatation, which was the most used option earlier, is now being discouraged. The Ventral Inlay Buccal Mucosal Graft Urethroplasty (VI BMGU) is one such reconstruction technique that is gaining popularity.( 5 , 6 ) There is ample evidence proving its long-term efficacy for the management of FUS.( 7 ) While the ideal catheterisation duration is unknown, it is a routine clinical practice to keep the catheter in situ for at least three weeks following female urethral reconstruction. However, prolonged catheterisation poses certain challenges: [1] Prolonged catheter-related symptoms, [2] Increased risk of Catheter-Associated Urinary Tract infections (CAUTI), [3] Increased requirement for antibiotic use, which is concerning given the global rise of antibiotic resistance, and [4] Discomfort and social stigma may restrict patients from resuming normal activities. Unlike onlay urethroplasties, a full-thickness incision is not made in VI BMGU. Only the mucosa and submucosal tissues are incised, and the Buccal Mucosal Graft (BMG) is fixed in an inlay fashion at the 6 o’clock position. It is believed that BMG acts as a scaffold for the urethra to re-epithelise at a larger calibre. The principles of free grafting suggest that initial imbibition and inosculation of the graft take place in the first 72 hours. Unlike males, the urethra is relatively straight and short in females. We assume that one week is good enough for the BMG to integrate, and we hypothesise that early catheter removal would be a safe strategy following VI BMGU. To test this hypothesis, we conducted a pilot study to evaluate the safety and feasibility of early catheter removal following VI BMGU. Materials and methods This was a single-centre, prospective observational pilot trial conducted between May 2023 and March 2025. The Institute Ethics Committee (IEC) approval ( T/IM-NF/Uro/22/177) and the Clinical Trials Registry of India (CTRI) registration were obtained before recruiting patients (CTRI/2023/05/066957) . Informed consent was obtained from all the participants, and all the procedures were conducted by adhering to the ethical principles in the Declaration of Helsinki. (8) The primary objective was to compare the success rate following early catheter removal on the seventh postoperative day following VI BMGU for FUS. All consenting females older than 18 years undergoing VI BMGU for FUS were included. Exclusion criteria included patients who did not give consent, had > grade I pelvic organ prolapse, had a history of prior urethroplasty, underwent ancillary procedure, or did not complete a minimum follow-up of six months. Secondary objectives included a comparison of patients’ preoperative American Urology Association (AUA) symptom score, maximum urinary flow rate (Qmax) and Post Void Residual volume (PVR) on transabdominal ultrasonography with those at the last follow-up. Additionally, the CAUTI rate per 1000 urinary catheter days was calculated. As this was the first pilot study of its kind, no formal sample size calculation was performed. A minimum of 20 patients were targeted for recruitment. Diagnostic criteria The screening criteria included an AUA symptom score >7, Qmax of 100ml and inability or difficulty to calibrate with a 12 Fr catheter. To confirm the diagnosis of FUS, cystourethroscopy with a 30 o 6 Fr pediatric scope (Olympus A3765A) was performed to visualise scarred urethral mucosa and narrowed lumen. The length and location of the stricture were noted. A Video Urodynamic Study (VUDS) or a combination of Voiding Cystourethrogram (VCUG) with a Urodynamic Study (UDS) was conducted whenever deemed necessary.(9) The failure was suspected on follow-up visits if there was an increased AUA symptom score, Qmax <12ml/sec, or failed calibration with an 18Fr catheter. Final confirmation was made by demonstrating a narrowed urethral segment on cystourethroscopy. Procedure The VIBMGU was performed as described by Nayak et al.(6) The urethra was progressively dilated by inserting a guidewire and passing a non-toothed forceps across its length. The strictured urethral mucosa was incised at 6 o’clock until the urethra was wide enough to allow a nasal speculum insertion. Homeostasis was achieved with judicious use of bipolar cautery. The buccal mucosa was fixed to the urethra at four points: two at the proximal edge of the incised urethra and two at the external meatus using PDS 5-0 sutures. Additional lateral stitches were taken if necessary. A 16 Fr silicone Foley catheter was placed to drain the bladder and provide extrinsic compression for the graft onto the urethral bed. The patients were discharged after 24 to 48 hours and were scheduled for catheter removal on the seventh postoperative day for catheter removal in an outpatient setting. All patients were prescribed oral antibiotics for seven days until the catheter was removed. A sterile preoperative urine culture was ensured in all patients, with repeat cultures obtained prior to catheter removal. Follow up The patients were followed up at postoperative one, three, and six months, followed by three monthly intervals. The first three follow-ups are mandatory. The AUA symptom score, PVR, and Qmax were recorded at each visit and entered prospectively in an electronic database. Statistical analysis Data was recorded in a predetermined proforma and managed on an Excel spreadsheet. The normalcy of data was checked using the Shapiro-Wilk test. Qualitative data was represented in the form of frequency (%), and quantitative data was represented as mean (standard deviation) for normal distribution and median (inter-quartile range) for non-normal distribution. Continuous variables were compared between the two groups using the student’s ‘t’ test (for normal distribution) and the Mann Whitney U and Wilcoxon rank sum (for non-normal distribution). Categorical variables were compared using the Chi-square (χ2) test/ Fisher’s exact test. Results were considered significant at p-value <0.05. SPSS version 29 (IBM, Chicago, Illinois) software was used for statistical analysis. Results A total of 23 patients were recruited. One patient had undiagnosed voiding dysfunction associated with FUS. She could not void following catheter removal and was started on clean intermittent catheterisation and was excluded. The remaining 22 patients are included in the analysis, with follow-up ranging from six to 18 months. The median follow-up duration was 12 months (9-15). The median age of the patients was 44 (40-48) years, while the median stricture length was 27.5 (12-38) mm. Two patients had a history of endourological procedures for the management of urolithiasis, while one patient had urethral caruncle excision. We considered these three patients to be possible iatrogenic strictures, while the remaining 86.36% of the patients were idiopathic. Over a third (36.36%) of the patients had undergone at least one prior urethral dilatation, with seven having had multiple dilatations. (Table 1) When compared to preoperative parameters, there was a significant improvement in median AUA scores [27 (24-32) vs 10 (8-12); p<0.01], Qmax [7 (5-9) vs 23.5 (19-28); p<0.01] and PVR [190 (135-240) vs 35 (30-40)]. (Table 2) Three patients had recurrence (first at one month, second at nine months and the third at 12 months, respectively). The first patient underwent dorsal onlay BMGU, the second had a repeat VI BMGU, and the third is awaiting surgery. (Table 3) Kaplan-Meier survival analysis estimated an 84% success rate at 18 months, as depicted in Figure 1. There were two documented cases of CAUTI, resulting in an incidence of 8.69%. The CAUTI rate per 1000 urinary catheter days was calculated at 12.42. Discussion Augmentation urethroplasty has emerged as the preferred treatment strategy for FUS in contemporary urology. Among various techniques of utilising buccal mucosal free grafts, the VI BMGU technique is gaining traction, supported by promising long-term outcomes. (5–7,10) However, the optimal duration of catheterisation following urethroplasty is a subject of debate. While prolonged catheter placement allows for the diversion of urine and promotes healing by keeping the anastomotic site relatively dry, it is associated with notable drawbacks: [1] Prolonged catheter-related symptoms, [2] Increased risk of Catheter-Associated Urinary Tract infections (CAUTI), [3] Increased requirement for antibiotic use, which is concerning given the global rise of antibiotic resistance, [4] Discomfort and social stigma may restrict patients from resuming normal activities. There has been a trend towards decreasing catheterisation time following male urethroplasties unless a long segment or complex reconstruction was performed. There are multiple reports of comparable results despite of decreasing catheter duration.(1–3) This has been proven beyond doubt in cases of excision and primary anastomosis where no grafts are employed and following vesicourethral anastomosis after prostatectomies.(11–16) For female urethroplasty, no standardised guidelines exist regarding when to remove the catheter. It has been done based on surgeon preference.(17) Reported practices vary, with catheterisation periods ranging from two to six weeks, with some protocols including Suprapubic Catheter (SPC) placement.(18–22) The VI BMGU traditionally described catheter removal after three to four weeks.(5,6) Unlike onlay urethroplasties, a full-thickness incision is not made in VI BMGU. The BMG is laid over the splayed urethral at 6 o’ clock position and is fixed with proximal and distal stitches. It is believed that BMG acts as a scaffold for the urethra to re-epithelise at a bigger calibre. The principles of free grafting state that initial imbibition and inosculation of the graft take place in the first 72 hours. Unlike in male urethroplasties, where urine has to pass through the turn at bulbar urethra and flexible pendulous urethra, the path is relatively straight and short in females. We assume that one week is good enough for the BMG to take up and we hypothesise that early catheter removal would be a safe strategy following VI BMGU. In this study, we observed three failures with an estimated success rate of 84% at 18-month follow-up. This outcome aligns with historical cohorts. Of the three failures, one patient failed at one month, potentially attributable to surgical technique. Overall, this study demonstrates that early catheter removal is a feasible strategy following VI BMGU, regardless of the stricture location or length, with durable outcomes. Furthermore, the CAUTI rate per 1000 urinary catheter days of 12.42 is much less than our previous data following prolonged catheterisation. This is crucial in promoting antibiotic stewardship, in the era of antibiotic resistance. Strengths of the study: This was a prospective study with medium-term follow-up. We could achieve a relatively decent sample size of 23, considering the low incidence of FUS. Limitations of the study: The absence of a comparative arm limits the ability to draw definitive conclusions. Conclusions Catheter removal on day seven following VI BMGU is a safe and effective strategy offering durable outcomes while reducing the risks associated with prolonged catheterisation. Larger randomised studies are warranted with comparison of different surgical techniques. Declarations Author Contribution VT: Conceptualization; Data collection; Formal analysis; Writing-original draft SM: Conceptualization; Validation; Writing-review and editing; SupervisionKS: Data Collection; Writing- review and editingMY: Data Collection; Formal analysis MD: Supervision; Validation; Writing-review and editingST: Supervision; Validation; Writing-review and editingKB: Supervision; Validation; Writing-review and editingPN: Supervision; Validation; Writing-review and editing References Pansadoro V, Emiliozzi P, Gaffi M, Scarpone P, DePaula F, Pizzo M. Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures. Urology. 2003 May;61(5):1008–10. Fichtner J, Filipas D, Fisch M, Hohenfellner R, Thüroff JW. Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair. Urology. 2004 Oct;64(4):648–50. Al-Qudah HS, Cavalcanti AG, Santucci RA. Early catheter removal after anterior anastomotic (3 days) and ventral buccal mucosal onlay (7 days) urethroplasty. Int Braz J Urol. 2005 Oct;31(5):459–64. Faiena I, Koprowski C, Tunuguntla H. Female Urethral Reconstruction. J Urol [Internet]. 2016 Mar [cited 2025 Jan 30]; Available from: https://www.auajournals.org/doi/10.1016/j.juro.2015.07.124 Hoag N, Gani J, Chee J. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique. Investig Clin Urol. 2016;57(4):298. Nayak P, Mandal S, Das M. Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture. Indian J Urol IJU J Urol Soc India. 2019;35(4):273–7. Gaur AS, Tarigopula V, Mandal S, Rohith G, Das MK, Tripathy S, et al. Comparison Of Ventral Inlay and Dorsal Onlay Urethroplasty For Female Urethral Stricture. Urology [Internet]. 2024 Jun 26 [cited 2024 Jul 29]; Available from: https://www.sciencedirect.com/science/article/pii/S0090429524005053 WMA - The World Medical Association-WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2024 Jun 22]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/ Solomon E, Yasmin H, Duffy M, Rashid T, Akinluyi E, Greenwell TJ. Developing and validating a new nomogram for diagnosing bladder outlet obstruction in women. Neurourol Urodyn. 2018 Jan;37(1):368–78. Kumaraswamy S, Mandal S, Das MK, Nayak P. Long-term Follow-up and Success Rate of Ventral Inlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture Disease. Urology. 2022 Aug 1;166:146–51. Jakse G, Marberger H. Excisional repair of urethral stricture Follow-up of 90 patients. Urology. 1986 Mar;27(3):233–6. Micheli E, Ranieri A, Peracchia G, Lembo A. End-to-end urethroplasty: long-term results. BJU Int. 2002 Jul;90(1):68–71. Bansal A, Sankhwar S, Gupta A, Singh K, Patodia M, Aeron R. Early removal of urinary catheter after excision and primary anastomosis in anterior urethral stricture. Türk Ürol DergisiTurkish J Urol. 2016 May 4;42(2):80–3. Ozu C, Hagiuda J, Nakagami Y, Hamada R, Horiguchi Y, Yoshioka K, et al. Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: Our experience: Running suture following RRP. Int J Urol. 2009 May;16(5):487–92. Noguchi M, Shimada A, Yahara J, Suekane S, Noda S. Early catheter removal 3 days after radical retropubic prostatectomy: Early catheter removal. Int J Urol. 2004 Nov;11(11):983–8. Lepor H, Nieder AM, Fraiman MC. Early removal of urinary catheter after radical retropubic prostatectomy is both feasible and desirable. Urology. 2001 Sep;58(3):425–9. EAU Guidelines on Non-neurogenic Female LUTS - Uroweb [Internet]. [cited 2025 Jan 15]. Available from: https://uroweb.org/guidelines/non-neurogenic-female-luts/chapter/disease-management Sharma GK, Pandey A, Bansal H, Swain S, Das SK, Trivedi S, et al. Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women. BJU Int. 2010 May;105(9):1309–12. Mukhtar BMB, Spilotros M, Malde S, Greenwell TJ. Ventral-onlay buccal mucosa graft substitution urethroplasty for urethral stricture in women. BJU Int. 2017 Nov;120(5):710–6. Migliari R, Leone P, Berdondini E, De Angelis M, Barbagli G, Palminteri E. Dorsal Buccal Mucosa Graft Urethroplasty for Female Urethral Strictures. J Urol. 2006 Oct;176(4):1473–6. Goel A, Paul S, Dalela D, Sankhwar P, Sankhwar SN, Singh V. Dorsal onlay buccal mucosal graft urethroplasty in female urethral stricture disease: a single-center experience. Int Urogynecology J. 2014 Apr;25(4):525–30. Berglund RK, Vasavada S, Angermeier K, Rackley R. Buccal mucosa graft urethroplasty for recurrent stricture of female urethra. Urology. 2006 May;67(5):1069–71. Tables Table 1: Table showing baseline characteristics of 22 patients undergoing VI BMGU following early catheter removal Median age in years (IQR) 44 (40-48) Median stricture length in mm (IQR) 27.5 (12-38) Median follow-up in months (IQR) 12 (9-15) Previous dilatation (%) 8 (36.36%) Previous periurethral or transurethral intervention (%) 3 (13.63%) Possible iatrogenic cause (%) 3 (13.63%) Idiopathic (%) 19 (86.36%) IQR: Interquartile range VI BMGU: Ventral Inlay Buccal Mucosal Graft Urethroplasty Table 2: Comparison of various secondary outcomes in follow-up after early catheter removal Time Preoperative Last follow-up P* Median AUA score (IQR) 27 (24-32) 10 (8-12) <0.01 Median Qmax in ml/s (IQR) 7 (5-9) 23.5 (19-28) <0.01 Median PVR in ml (IQR) 190 (135-240) 35 (30-40) <0.01 AUA: American Urological Association symptom score Qmax: Peak flow rate on uroflowmetry PVR: Post-void residue on ultrasonography IQR: Interquartile range *Friedman test Table 3: Table showing patient demographics, follow-up, and success rates following early catheter removal after VI BMGU Patient number Age Location of stricture Length of stricture (mm) Preoperative AUA Preoperative Qmax (ml/s) Preoperative PVR (ml) Follow-up period (months) Latest AUA Latest Qmax (ml/s) Latest PVR (ml) Outcome 1 48 pan 45 33 4 400 18 9 26 40 success 2 57 mid+distal 30 24 6 240 15 10 17 40 success 3 42 pan 40 27 12 139 15 8 18 20 success 4 44 mid+distal 25 34 8 239 15 9 20 30 success 5 42 distal 20 22 9 86 18 14 22 20 Success 6 48 pan 37 21 10 154 6 12 31 30 Censor 7 45 distal 7 32 9 180 15 7 30 40 Success 8 33 pan 35 20 11 60 15 12 21 30 Success 9 38 mid+distal 10 24 15 850 12 22 9 240 Failure at 12 months 10 35 mid 5 34 7 135 12 12 20 10 Success 11 51 Pan 38 29 5 76 12 5 19 20 Success 12 46 Pan 40 26 5 190 1 24 3 160 Failure at 1 month 13 45 proximal 10 24 3 70 12 10 26 10 Success 14 42 Pan 40 32 9 180 9 29 5 220 Failure at 9 months 15 29 Mid+distal 25 27 6 220 9 9 28 40 Success 16 44 proximal + mid 20 33 9 190 9 6 32 40 Success 17 40 mid 12 27 7 240 9 7 30 35 success 18 43 pan 35 20 5 180 9 8 25 30 Success 19 70 proximal 12 27 6 220 6 9 28 40 Success 20 65 mid and proximal 15 24 8 100 6 13 27 35 Success 21 39 distal mid 30 28 5 400 12 10 20 130 Success 22 56 pan 42 28 3 300 6 10 34 40 Censor AUA: American Urological Association symptom score Qmax: peak flow rate on uroflowmetry PVR: post-void residue on ultrasonography VI BMGU: Ventral Inlay Buccal Mucosal Graft Urethroplasty Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6569951","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453616340,"identity":"00b087fc-9cae-4b65-864b-ef04812c13e3","order_by":0,"name":"Vivek Tarigopula","email":"","orcid":"","institution":"All India Institute of Medical Sciences Bhubaneswar","correspondingAuthor":false,"prefix":"","firstName":"Vivek","middleName":"","lastName":"Tarigopula","suffix":""},{"id":453616341,"identity":"c96ad52b-c394-4878-9726-d90a24957d60","order_by":1,"name":"Swarnendu 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07:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6569951/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6569951/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11255-025-04629-5","type":"published","date":"2025-07-03T15:58:39+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82558857,"identity":"b940f30b-2c89-4aa0-aaa5-0bc6ce1e4a86","added_by":"auto","created_at":"2025-05-13 01:23:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40369,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan-Meier survival analysis of patients who underwent VI BMGU following early catheter removal\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVI BMGU: Ventral Inlay Buccal Mucosal Graft Urethroplasty\u003c/p\u003e\n\u003cp\u003eShaded area: 95% confidence intervals\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-6569951/v1/58be65409b037e9f34c18659.png"},{"id":86179664,"identity":"5a298f70-71fb-43a8-8416-e89eed7c7212","added_by":"auto","created_at":"2025-07-07 16:18:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":887028,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6569951/v1/b9168434-66d1-4757-8e8e-d6694bb76055.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Early Catheter Removal on Seventh Postoperative Day Following Ventral Inlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: A Pilot Study ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThere has been a trend towards decreasing catheterisation time following male urethroplasties. There are multiple reports of comparable results despite of decreasing catheter duration.(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) This has not been explored in the realm of female urethroplasties. Female Urethral Stricture (FUS) is one of the least understood and studied conditions in the field of Urology. It\u0026rsquo;s true incidence remains unclear, with some estimates suggesting it accounts for less than 10% of females with bladder outlet obstruction.(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) While diagnosis of this entity is not as straightforward as in male patients, the ideal management strategy is debated the world over, adding to the enigma. With emerging evidence on urethral reconstruction techniques, urethral dilatation, which was the most used option earlier, is now being discouraged. The Ventral Inlay Buccal Mucosal Graft Urethroplasty (VI BMGU) is one such reconstruction technique that is gaining popularity.(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) There is ample evidence proving its long-term efficacy for the management of FUS.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eWhile the ideal catheterisation duration is unknown, it is a routine clinical practice to keep the catheter in situ for at least three weeks following female urethral reconstruction. However, prolonged catheterisation poses certain challenges: [1] Prolonged catheter-related symptoms, [2] Increased risk of Catheter-Associated Urinary Tract infections (CAUTI), [3] Increased requirement for antibiotic use, which is concerning given the global rise of antibiotic resistance, and [4] Discomfort and social stigma may restrict patients from resuming normal activities.\u003c/p\u003e \u003cp\u003eUnlike onlay urethroplasties, a full-thickness incision is not made in VI BMGU. Only the mucosa and submucosal tissues are incised, and the Buccal Mucosal Graft (BMG) is fixed in an inlay fashion at the 6 o\u0026rsquo;clock position. It is believed that BMG acts as a scaffold for the urethra to re-epithelise at a larger calibre. The principles of free grafting suggest that initial imbibition and inosculation of the graft take place in the first 72 hours. Unlike males, the urethra is relatively straight and short in females. We assume that one week is good enough for the BMG to integrate, and we hypothesise that early catheter removal would be a safe strategy following VI BMGU. To test this hypothesis, we conducted a pilot study to evaluate the safety and feasibility of early catheter removal following VI BMGU.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis was a single-centre, prospective observational pilot trial conducted between May 2023 and March 2025. The Institute Ethics Committee (IEC) approval (\u003cstrong\u003eT/IM-NF/Uro/22/177)\u0026nbsp;\u003c/strong\u003eand the Clinical Trials Registry of India (CTRI) registration were obtained before recruiting patients\u0026nbsp;\u003cstrong\u003e(CTRI/2023/05/066957)\u003c/strong\u003e.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all the participants, and all the procedures were conducted by adhering to the ethical principles in the Declaration of Helsinki. (8)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary objective was to compare the success rate following early catheter removal on the seventh postoperative day following VI BMGU for FUS. All consenting females older than 18 years undergoing VI BMGU for FUS were included. Exclusion criteria included patients who did not give consent, had \u0026gt; grade I pelvic organ prolapse, had a history of prior urethroplasty, underwent ancillary procedure, or did not complete a minimum follow-up of six months. Secondary objectives included a comparison of patients\u0026rsquo; preoperative\u0026nbsp;American Urology Association (AUA) symptom score, maximum urinary flow rate (Qmax) and Post Void Residual volume (PVR) on transabdominal ultrasonography with those at the last follow-up. Additionally, the CAUTI rate per 1000 urinary catheter days was calculated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs this was the first pilot study of its kind, no formal sample size calculation was performed. A minimum of 20 patients were targeted for recruitment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe screening criteria included an AUA symptom score \u0026gt;7, Qmax of \u0026lt;12 ml/s or presence of thick trabeculated bladder on ultrasonography with a PVR \u0026gt; 100ml and inability or difficulty to calibrate with a 12 Fr catheter. To confirm the diagnosis of FUS, cystourethroscopy with a 30\u003csup\u003eo\u0026nbsp;\u003c/sup\u003e6 Fr pediatric scope (Olympus A3765A) was performed to visualise scarred urethral mucosa and narrowed lumen. The length and location of the stricture were noted. A Video Urodynamic Study (VUDS) or a combination of Voiding Cystourethrogram (VCUG) with a Urodynamic Study (UDS) was conducted whenever deemed necessary.(9)\u0026nbsp;The failure was suspected on follow-up visits if there was an increased AUA symptom score, Qmax \u0026lt;12ml/sec, or failed calibration with an 18Fr catheter. Final confirmation was made by demonstrating a narrowed urethral segment on cystourethroscopy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe VIBMGU was performed as described by Nayak et al.(6)\u0026nbsp;The urethra was progressively dilated by inserting a guidewire and passing a non-toothed forceps across its length. The strictured urethral mucosa was incised at 6 o\u0026rsquo;clock until the urethra was wide enough to allow a nasal speculum insertion. Homeostasis was achieved with judicious use of bipolar cautery. The buccal mucosa was fixed to the urethra at four points: two at the proximal edge of the incised urethra and two at the external meatus using PDS 5-0 sutures. Additional lateral stitches were taken if necessary. A 16 Fr silicone Foley catheter was placed to drain the bladder and provide extrinsic compression for the graft onto the urethral bed. The patients were discharged after 24 to 48 hours and were scheduled for catheter removal on the seventh postoperative day for catheter removal in an outpatient setting. All patients were prescribed oral antibiotics for seven days until the catheter was removed. A sterile preoperative urine culture was ensured in all patients, with repeat cultures obtained prior to catheter removal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients were followed up at postoperative one, three, and six months, followed by three monthly intervals. The first three follow-ups are mandatory. The AUA symptom score, PVR, and Qmax were recorded at each visit and entered prospectively in an electronic database.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was recorded in a predetermined proforma and managed on an Excel spreadsheet. The normalcy of data was checked using the Shapiro-Wilk test. Qualitative data was represented in the form of frequency (%), and quantitative data was represented as mean (standard deviation) for normal distribution and median (inter-quartile range) for non-normal distribution. Continuous variables were compared between the two groups using the student\u0026rsquo;s \u0026lsquo;t\u0026rsquo; test (for normal distribution) and the Mann Whitney U and Wilcoxon rank sum (for non-normal distribution). Categorical variables were compared using the Chi-square (\u0026chi;2) test/ Fisher\u0026rsquo;s exact test. Results were considered significant at p-value \u0026lt;0.05. SPSS version 29 (IBM, Chicago, Illinois) software was used for statistical analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 23 patients were recruited. One patient had undiagnosed voiding dysfunction associated with FUS. She could not void following catheter removal and was started on clean intermittent catheterisation and was excluded. The remaining 22 patients are included in the analysis, with follow-up ranging from six to 18 months. The median follow-up duration was 12 months (9-15).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe median age of the patients was\u0026nbsp;44 (40-48) years, while the median stricture length was 27.5 (12-38) mm. Two patients had a history of endourological procedures for the management of urolithiasis, while one patient had urethral caruncle excision. We considered these three patients to be possible iatrogenic strictures, while the remaining 86.36% of the patients were idiopathic. Over a third \u0026nbsp;(36.36%) of the patients had undergone at least one prior urethral dilatation, with seven having had multiple dilatations. (Table 1)\u003c/p\u003e\n\u003cp\u003eWhen compared to preoperative parameters, there was a significant improvement in median AUA scores [27 (24-32) vs 10 (8-12); p\u0026lt;0.01], Qmax [7 (5-9) vs 23.5 (19-28); p\u0026lt;0.01] and PVR [190 (135-240) vs 35 (30-40)]. (Table 2)\u003c/p\u003e\n\u003cp\u003eThree patients had recurrence (first at one month, second at nine months and the third at 12 months, respectively). \u0026nbsp;The first patient underwent dorsal onlay BMGU, the second had a repeat VI BMGU, and the third is awaiting surgery. (Table 3) Kaplan-Meier survival analysis estimated an 84% success rate at 18 months, as depicted in Figure 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere were two documented cases of CAUTI, resulting in an incidence of 8.69%. The CAUTI rate per 1000 urinary catheter days was calculated at 12.42.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAugmentation urethroplasty has emerged as the preferred treatment strategy for FUS in contemporary urology. Among various techniques of utilising buccal mucosal free grafts, the VI BMGU technique is gaining traction, supported by promising long-term outcomes. (5\u0026ndash;7,10) However, the optimal duration of catheterisation following urethroplasty is a subject of debate. While prolonged catheter placement allows for the diversion of urine and promotes healing by keeping the anastomotic site relatively dry, it is associated with notable drawbacks: [1] Prolonged catheter-related symptoms, [2] Increased risk of Catheter-Associated Urinary Tract infections (CAUTI), [3] Increased requirement for antibiotic use, which is concerning given the global rise of antibiotic resistance, [4] Discomfort and social stigma may restrict patients from resuming normal activities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere has been a trend towards decreasing catheterisation time following male urethroplasties unless a long segment or complex reconstruction was performed. There are multiple reports of comparable results despite of decreasing catheter duration.(1\u0026ndash;3) This has been proven beyond doubt in cases of excision and primary anastomosis where no grafts are employed and following vesicourethral anastomosis after prostatectomies.(11\u0026ndash;16)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor female urethroplasty, no standardised guidelines exist regarding when to remove the catheter. It has been done based on surgeon preference.(17) Reported practices vary, with catheterisation periods ranging from two to six weeks, with some protocols including Suprapubic Catheter (SPC) placement.(18\u0026ndash;22) The VI BMGU traditionally described catheter removal after three to four weeks.(5,6)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUnlike onlay urethroplasties, a full-thickness incision is not made in VI BMGU. The BMG is laid over the splayed urethral at 6 o\u0026rsquo; clock position and is fixed with proximal and distal stitches. It is believed that BMG acts as a scaffold for the urethra to re-epithelise at a bigger calibre. The principles of free grafting state that initial imbibition and inosculation of the graft take place in the first 72 hours. Unlike in male urethroplasties, where urine has to pass through the turn at bulbar urethra and flexible pendulous urethra, the path is relatively straight and short in females. We assume that one week is good enough for the BMG to take up and we hypothesise that early catheter removal would be a safe strategy following VI BMGU.\u003c/p\u003e\n\u003cp\u003eIn this study, we observed three failures with an estimated success rate of 84% at 18-month follow-up. This outcome aligns with historical cohorts. Of the three failures, one patient failed at one month, potentially attributable to surgical technique. Overall, this study demonstrates that early catheter removal is a feasible strategy following VI BMGU, regardless of the stricture location or length, with durable outcomes. Furthermore, the\u0026nbsp;CAUTI rate per 1000 urinary catheter days of 12.42 is much less than our previous data following prolonged catheterisation. This is crucial in promoting antibiotic stewardship, in the era of antibiotic resistance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths of the study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a prospective study with medium-term follow-up. We could achieve a relatively decent sample size of 23, considering the low incidence of FUS.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe absence of a comparative arm limits the ability to draw definitive conclusions. \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eCatheter removal on day seven following VI BMGU is a safe and effective strategy offering durable outcomes while reducing the risks associated with prolonged catheterisation. Larger randomised studies are warranted with comparison of different surgical techniques.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eVT: Conceptualization; Data collection; Formal analysis; Writing-original draft SM: Conceptualization; Validation; Writing-review and editing; SupervisionKS: Data Collection; Writing- review and editingMY: Data Collection; Formal analysis MD: Supervision; Validation; Writing-review and editingST: Supervision; Validation; Writing-review and editingKB: Supervision; Validation; Writing-review and editingPN: Supervision; Validation; Writing-review and editing\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePansadoro V, Emiliozzi P, Gaffi M, Scarpone P, DePaula F, Pizzo M. Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures. Urology. 2003 May;61(5):1008\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eFichtner J, Filipas D, Fisch M, Hohenfellner R, Th\u0026uuml;roff JW. Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair. Urology. 2004 Oct;64(4):648\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eAl-Qudah HS, Cavalcanti AG, Santucci RA. Early catheter removal after anterior anastomotic (3 days) and ventral buccal mucosal onlay (7 days) urethroplasty. Int Braz J Urol. 2005 Oct;31(5):459\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eFaiena I, Koprowski C, Tunuguntla H. Female Urethral Reconstruction. J Urol [Internet]. 2016 Mar [cited 2025 Jan 30]; Available from: https://www.auajournals.org/doi/10.1016/j.juro.2015.07.124\u003c/li\u003e\n\u003cli\u003eHoag N, Gani J, Chee J. Vaginal-sparing ventral buccal mucosal graft urethroplasty for female urethral stricture: A novel modification of surgical technique. Investig Clin Urol. 2016;57(4):298. \u003c/li\u003e\n\u003cli\u003eNayak P, Mandal S, Das M. Ventral-inlay buccal mucosal graft urethroplasty for female urethral stricture. Indian J Urol IJU J Urol Soc India. 2019;35(4):273\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eGaur AS, Tarigopula V, Mandal S, Rohith G, Das MK, Tripathy S, et al. Comparison Of Ventral Inlay and Dorsal Onlay Urethroplasty For Female Urethral Stricture. Urology [Internet]. 2024 Jun 26 [cited 2024 Jul 29]; Available from: https://www.sciencedirect.com/science/article/pii/S0090429524005053\u003c/li\u003e\n\u003cli\u003eWMA - The World Medical Association-WMA Declaration of Helsinki \u0026ndash; Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2024 Jun 22]. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/\u003c/li\u003e\n\u003cli\u003eSolomon E, Yasmin H, Duffy M, Rashid T, Akinluyi E, Greenwell TJ. Developing and validating a new nomogram for diagnosing bladder outlet obstruction in women. Neurourol Urodyn. 2018 Jan;37(1):368\u0026ndash;78. \u003c/li\u003e\n\u003cli\u003eKumaraswamy S, Mandal S, Das MK, Nayak P. Long-term Follow-up and Success Rate of Ventral Inlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture Disease. Urology. 2022 Aug 1;166:146\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eJakse G, Marberger H. Excisional repair of urethral stricture Follow-up of 90 patients. Urology. 1986 Mar;27(3):233\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eMicheli E, Ranieri A, Peracchia G, Lembo A. End-to-end urethroplasty: long-term results. BJU Int. 2002 Jul;90(1):68\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eBansal A, Sankhwar S, Gupta A, Singh K, Patodia M, Aeron R. Early removal of urinary catheter after excision and primary anastomosis in anterior urethral stricture. T\u0026uuml;rk \u0026Uuml;rol DergisiTurkish J Urol. 2016 May 4;42(2):80\u0026ndash;3. \u003c/li\u003e\n\u003cli\u003eOzu C, Hagiuda J, Nakagami Y, Hamada R, Horiguchi Y, Yoshioka K, et al. Radical retropubic prostatectomy with running vesicourethral anastomosis and early catheter removal: Our experience: Running suture following RRP. Int J Urol. 2009 May;16(5):487\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eNoguchi M, Shimada A, Yahara J, Suekane S, Noda S. Early catheter removal 3 days after radical retropubic prostatectomy: Early catheter removal. Int J Urol. 2004 Nov;11(11):983\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eLepor H, Nieder AM, Fraiman MC. Early removal of urinary catheter after radical retropubic prostatectomy is both feasible and desirable. Urology. 2001 Sep;58(3):425\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eEAU Guidelines on Non-neurogenic Female LUTS - Uroweb [Internet]. [cited 2025 Jan 15]. Available from: https://uroweb.org/guidelines/non-neurogenic-female-luts/chapter/disease-management\u003c/li\u003e\n\u003cli\u003eSharma GK, Pandey A, Bansal H, Swain S, Das SK, Trivedi S, et al. Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women. BJU Int. 2010 May;105(9):1309\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eMukhtar BMB, Spilotros M, Malde S, Greenwell TJ. Ventral-onlay buccal mucosa graft substitution urethroplasty for urethral stricture in women. BJU Int. 2017 Nov;120(5):710\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eMigliari R, Leone P, Berdondini E, De Angelis M, Barbagli G, Palminteri E. Dorsal Buccal Mucosa Graft Urethroplasty for Female Urethral Strictures. J Urol. 2006 Oct;176(4):1473\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eGoel A, Paul S, Dalela D, Sankhwar P, Sankhwar SN, Singh V. Dorsal onlay buccal mucosal graft urethroplasty in female urethral stricture disease: a single-center experience. Int Urogynecology J. 2014 Apr;25(4):525\u0026ndash;30. \u003c/li\u003e\n\u003cli\u003eBerglund RK, Vasavada S, Angermeier K, Rackley R. Buccal mucosa graft urethroplasty for recurrent stricture of female urethra. Urology. 2006 May;67(5):1069\u0026ndash;71. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Table showing baseline characteristics of 22 patients undergoing VI BMGU following early catheter removal\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eMedian age in years (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e44 (40-48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eMedian stricture length in mm (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e27.5 (12-38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eMedian follow-up in months (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e12 (9-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003ePrevious dilatation (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8 (36.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003ePrevious periurethral or transurethral intervention (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (13.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003ePossible iatrogenic cause (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (13.63%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 368px;\"\u003e\n \u003cp\u003eIdiopathic (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e19 (86.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIQR: Interquartile range\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVI BMGU: Ventral Inlay Buccal Mucosal Graft Urethroplasty\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2: Comparison of various secondary outcomes in follow-up after early catheter removal\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLast follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian AUA score (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e27 (24-32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10 (8-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian Qmax in ml/s (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e7 (5-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e23.5 (19-28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian PVR in ml (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e190 (135-240)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e35 (30-40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;AUA: American Urological Association symptom score\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQmax: Peak flow rate on uroflowmetry\u003c/p\u003e\n\u003cp\u003ePVR: Post-void residue on ultrasonography\u003c/p\u003e\n\u003cp\u003eIQR: Interquartile range\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*Friedman test\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 3: Table showing patient demographics, follow-up, and success rates following early catheter removal after VI BMGU\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"992\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation of stricture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of stricture (mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative AUA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative Qmax (ml/s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative PVR (ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up period (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLatest AUA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLatest Qmax (ml/s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLatest PVR (ml)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003epan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003esuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003emid+distal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003esuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003epan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003esuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003emid+distal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003esuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003edistal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003epan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCensor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003edistal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003epan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003emid+distal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFailure at 12 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003emid\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFailure at 1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003eproximal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003ePan\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFailure at 9 months\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMid+distal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003eproximal + mid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003emid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003esuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003epan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003eproximal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003emid and proximal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003edistal mid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSuccess \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 69px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 41px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003epan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCensor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAUA: American Urological Association symptom score\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQmax: peak flow rate on uroflowmetry\u003c/p\u003e\n\u003cp\u003ePVR: post-void residue on ultrasonography\u003c/p\u003e\n\u003cp\u003eVI BMGU: Ventral Inlay Buccal Mucosal Graft Urethroplasty\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6569951/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6569951/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: While the ideal catheterisation time following augmentation urethroplasty is unknown, there is emerging evidence of comparable long-term results of decreasing it in male urethroplasties. This has not been studied in females. Prolonged catheterisation leads to increased patient discomfort and catheter-related urinary-tract-infections (CAUTI). We attempted to study the feasibility and efficacy of catheter removal on the seventh postoperative day following ventral inlay buccal mucosal graft urethroplasty (VI BMGU) for female urethral stricture (FUS).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This was a single-centre, prospective observational pilot study conducted between May 2023 and July 2024. [Ethics committee approval: T/IM-NF/Uro/22/177; Clinical Trials Registry of India: CTRI/2023/05/066957]. Consenting females undergoing VI BMGU for FUS were included. The primary objective was success rate at a minimum follow-up of 6 months, while secondary objectives were a comparison of the American-Urological-Association (AUA) symptom score, maximum urinary flow rate (Qmax) and Postvoid Residual volume (PVR) and CAUTI rate per 1000 urinary catheter days.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Twenty three patients were recruited, and 22 were included in the final analysis with a median follow up of 12 (9-15) months. There were three recurrences, with an estimated success rate of 84% at 18 months. Compared to preoperative parameters, there were significant improvements in median AUA scores, Qmax and PVR. The CAUTI rate per 1000 urinary catheter days was calculated at 12.42.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Catheter removal on day seven following VI BMGU is a safe and effective strategy offering durable outcomes while reducing the risks associated with prolonged catheterisation. Larger randomised studies are warranted with a comparison of different surgical techniques. \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Early Catheter Removal on Seventh Postoperative Day Following Ventral Inlay Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: A Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-13 01:23:31","doi":"10.21203/rs.3.rs-6569951/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d9d91512-d83c-4cad-b2d7-e037eb52da5d","owner":[],"postedDate":"May 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:08:29+00:00","versionOfRecord":{"articleIdentity":"rs-6569951","link":"https://doi.org/10.1007/s11255-025-04629-5","journal":{"identity":"international-urology-and-nephrology","isVorOnly":false,"title":"International Urology and Nephrology"},"publishedOn":"2025-07-03 15:58:39","publishedOnDateReadable":"July 3rd, 2025"},"versionCreatedAt":"2025-05-13 01:23:31","video":"","vorDoi":"10.1007/s11255-025-04629-5","vorDoiUrl":"https://doi.org/10.1007/s11255-025-04629-5","workflowStages":[]},"version":"v1","identity":"rs-6569951","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6569951","identity":"rs-6569951","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}