Open research questions in Urological Disorders and Treatments

What the literature leaves open

• The study has a limited sample size, with only 36 patients included in the analysis. The study acknowledges that the cohort is highly selected and that the rates may not be representative of the general hypospadias population.

  Clinical Factors Associated with Anxiety Disorders in Adults with Childhood Hypospadias Repair: Results from the F.R.E.S.H. Study · 2026 · DOI

• Previous studies have focused on intraoperative and postoperative factors, but little attention has been paid to preoperative factors. There is a lack of data specifically addressing the role of preoperative urethral catheterization in postoperative urethral stricture development.

  The relationship between urethral catheterization before TUR-P and postoperative stricture · 2026 · DOI

• There is a lack of comparative data between ODCB and DVIU for the management of anterior urethral strictures. Current treatments, such as DVIU, have high recurrence rates, highlighting the need for alternative procedures with more durable long-term outcomes.

  Internal urethrotomy versus Optilume™ drug-coated balloon dilatation for the management of anterior urethral strictures: morbidity comparison of the techniques · 2026 · DOI

• The potential consequences of preserving the preputial subcutaneous layer in distal hypospadias surgery on penile sensation are unknown. The histopathological differences between full dorsal skin and dissected TIPU skin are not well understood.

  Does preserving the preputial subcutaneous layer in distal hypospadias surgery harbor potential consequences for penile sensation? · 2026 · DOI

• The study acknowledges that the younger age of the hypospadias cohort may confound observed differences in immune cell counts, inflammatory markers, and microbial profiles. Prolonged diaper use is a known risk factor for periurethral colonization by Escherichia coli and increased the risk of urinary tract inflammation. The study has a limited sample size, which may impact the generalizability of the findings.

  Integrated analysis of extrachromosomal circular DNA and transcriptome reveals associations between microbial profiles and Immunoinflammatory markers in hypospadias · 2026 · DOI

• Current treatment methods have limitations and complications. The need for a safe and effective surgical technique for repairing long-segment anterior urethral strictures.

  Preliminary experience and outcomes of modified distal penile circular fasciocutaneous flap for the treatment of anterior urethral strictures · 2026 · DOI

• Limited understanding of the long-term efficacy and safety of Wharton's jelly-derived MSC injections for urethral stricture.

  A first-in-human pilot study of Wharton’s jelly-derived mesenchymal stem cell injection for urethral stricture: safety and preliminary efficacy · 2026 · DOI

• Data on preoperative predictors of failure following female urethroplasty remain limited. Existing literature has focused predominantly on overall success rates and technical variations, rather than identifying factors associated with failure.

  Factors predicting success following female urethroplasty: an observational study · 2026 · DOI

• There is a lack of evidence specifically addressing recurrences after prior urethroplasty. Pivotal trials often excluded previously reconstructed patients. There is a need for effective treatment options for recurrent urethral strictures after urethroplasty.

  Efficacy of the optilume® drug-coated balloon for recurrent urethral stricture after prior urethroplasty: a 12-month multicenter follow-up study · 2026 · DOI

• Urethral erosion is a challenging complication of AUS implantation, with a high risk of urethral stricture. Immediate urethral repair requires careful consideration of the urethral defect and the need for tension-free anastomosis. Postoperative management must balance the need for urethral healing with the risk of infection and urethral stricture.

  In situ urethroplasty at the time of artificial urinary sphincter explantation for urethral erosion: an 18-year single-center experience · 2026 · DOI

• Limited literature on the outcomes of in situ urethroplasty for urethral erosion. Uncertainty about the effectiveness of immediate urethral repair in preventing urethral stricture. Need for a consistently applied surgical strategy to manage urethral erosion.

  In situ urethroplasty at the time of artificial urinary sphincter explantation for urethral erosion: an 18-year single-center experience · 2026 · DOI

• The available evidence cannot distinguish intervention-associated closure from the natural healing potential of carefully selected early fistulas. The heterogeneity of the evidence base makes interpretation of treatment efficacy challenging. The lack of standardized observation-only comparator makes it difficult to attribute closure to the intervention itself.

  Treatment effect or natural healing? Interpreting non-operative management of early urethrocutaneous fistulas after hypospadias repair · 2026 · DOI

• The study had a limited sample size. The distribution of events across some covariate categories was sparse. The study was retrospective.

  Outcomes of patients undergoing Optilume® drug-coated balloon for different locations of urethral strictures: results from a multicenter cohort · 2026 · DOI

• The use of retrograde urethrography is low. Urethroplasty is underused, favoring repeated DVIU and dilatation. There is a significant variation in practice among urologists.

  Management of urethral stricture: translating guidelines into clinical practice · 2026 · DOI

• Small cohort size (N = 20), - Retrospective study design, - Limited follow-up period…

  Dorsal inlay lingual mucosa graft urethroplasty with artificial dermis donor repair for female urethral stricture · 2026 · DOI

• Investigate the long-term effects of preserving the preputial subcutaneous layer on penile sensation and sexual function - Compare the outcomes of different surgical techniques for hypospadias…

  Does preserving the preputial subcutaneous layer in distal hypospadias surgery harbor potential consequences for penile sensation? · 2026 · DOI

• A formal a priori sample size calculation (power analysis) was not performed - The number of animals per group was determined based on previous experimental urethral stricture models in the literature and the 3R (replacement, reduction, refinement) principles - The study was conducted with a limited number of animals…

  Hyperbaric oxygen therapy attenuates urethral stricture formation after urethral injury: an experimental rabbit study · 2026 · DOI

• Investigate the effects of E. coli on urethral fibrosis and inflammation in human subjects, - Examine the role of other microbial alterations in the pathogenesis of urethral stricture, - Explore the potential therapeutic applications of targeting the TGF-β/Smad signaling pathway in urethral fibrosis…

  Escherichia coli promotes myofibroblast differentiation in urethral fibrosis urethral stricture in vivo and vitro via regulating TGFβ/Smad signaling pathway · 2026 · DOI

• Investigating the reasons for low adherence to guidelines, - Studying the effectiveness of different treatment options, - Examining the impact of academic vs non-academic settings on treatment…

  Management of urethral stricture: translating guidelines into clinical practice · 2026 · DOI

• Larger, multicenter studies with longer follow-up periods, - Comparison with existing treatments, - Investigation of optimal MSC dosage and administration schedule, - Exploration of MSC therapy for other urological…

  A first-in-human pilot study of Wharton’s jelly-derived mesenchymal stem cell injection for urethral stricture: safety and preliminary efficacy · 2026 · DOI

• The study was retrospective, - The sample size was limited to 91 patients, - There was no comparison to other treatment options, - The follow-up period was limited to 72…

  Factors predicting success following female urethroplasty: an observational study · 2026 · DOI

• Small sample sizes in previous studies - Lack of suitable comparison groups from the same population - Limited to patients enrolled in the participating KP sites - Data based on electronic health…

  Mental health diagnoses among patients with complex hypospadias · 2026 · DOI

• Further studies with randomized allocation and larger sample sizes are needed, - investigation of long-term outcomes and comparison of different surgical…

  Selective use of grafted TIP urethroplasty in distal to proximal penile hypospadias: a single-center cohort study · 2026 · DOI

• Future prospective studies should use standardized eligibility criteria and separately evaluate structured observation, recatheterization, and adhesive-based…

  Treatment effect or natural healing? Interpreting non-operative management of early urethrocutaneous fistulas after hypospadias repair · 2026 · DOI

• Further studies are needed to investigate the relationship between complex hypospadias and mental health problems - Research should focus on the underlying causes of the increased risk of mental health problems in patients with complex hypospadias - Studies should aim to develop effective interventions to address mental health issues in patients with complex…

  Mental health diagnoses among patients with complex hypospadias · 2026 · DOI

Most-cited papers in Urological Disorders and Treatments

• Enuresis—A method for its study and treatment. · American Journal of Orthopsychiatry · 1938 · 353 citations
• The erector spinae plane (ESP) block: A pooled review of 242 cases · Journal of Clinical Anesthesia · 2018 · 306 citations
• The prevalence of major abnormalities of the levator ani in urogynaecological patients · BJOG An International Journal of Obstetrics & Gynaecology · 2006 · 241 citations
• Acute Pyogenic Meningitis Probably Due to Acanthamoeba sp.: a Preliminary Report · BMJ · 1965 · 224 citations
• Hypospadias and endocrine disruption: is there a connection? · Environmental Health Perspectives · 2001 · 218 citations
• Gender Identity Outcome in Female-Raised 46,XY Persons with Penile Agenesis, Cloacal Exstrophy of the Bladder, or Penile Ablation · Archives of Sexual Behavior · 2005 · 200 citations
• Efficacy of high condylectomy for management of condylar hyperplasia · American Journal of Orthodontics and Dentofacial Orthopedics · 2002 · 150 citations
• Ablatio penis: Normal male infant sex-reassigned as a girl · Archives of Sexual Behavior · 1975 · 130 citations
• A SIMPLE TRANSDUCER FOR MECHANICAL PLETHYSMOGRAPHY OF THE MALE GENITAL · Journal of the Experimental Analysis of Behavior · 1965 · 126 citations
• Erector spinae plane block: A narrative review with systematic analysis of the evidence pertaining to clinical indications and alternative truncal blocks · Journal of Clinical Anesthesia · 2020 · 114 citations

Most recent work

• Autologous platelet-rich plasma graft as an additional covering layer in snodgrass repair of distal hypospadias: A randomized controlled trial · Journal of Pediatric Urology · 2026
• Efficacy of three corporotomies to correct ventral penile curvature. Experience in 400 patients with severe hypospadias · Journal of Pediatric Urology · 2026
• Ventral flap aided glans urethral disassembly (V-GUD) technique for distal hypospadias · Journal of Pediatric Urology · 2026
• Nurse-led postoperative telemonitoring program following outpatient urethroplasty: a pilot study · World Journal of Urology · 2026
• The relationship between urethral catheterization before TUR-P and postoperative stricture · World Journal of Urology · 2026
• Internal urethrotomy versus Optilume™ drug-coated balloon dilatation for the management of anterior urethral strictures: morbidity comparison of the techniques · World Journal of Urology · 2026
• Maternal and perinatal risk factors of hypospadias: A case–control study · Journal of Pediatric Urology · 2026
• Clinical manifestations and management of prune-belly syndrome: A 20-year single center experience · Journal of Pediatric Urology · 2026
• Use of platelet rich plasma gel in preventing healing complications of tubularised incised plate urethroplasty in children with distal and mid-penile hypospadias – A randomized clinical trial · Journal of Pediatric Urology · 2026
• Caudal versus penile block and urethrocutaneous fistula formation following hypospadias repair in children <2 years: a multicenter randomized clinical trial · Regional Anesthesia & Pain Medicine · 2026

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