A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis

Policastro, Connor; Simhan, Jay; Martins, Francisco E.; Lumen, Nicolaas; Venkatesan, Krishnan; Angulo, Javier C.; Gupta, Shubham; Rusilko, Paul; Pérez, Erick Alejandro Ramírez; Redger, Kirk; Flynn, Brian J.; Hughes, Michael; Blakely, Stephen; Nikolavsky, Dmitriy

doi:10.1007/s00345-020-03446-y

Cited by 19 publications

(11 citation statements)

References 31 publications

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“…There is increasing evidence that membranous dorsal onlay urethroplasty, not only in the context of radiation but also after TURP, does not compromise continence or erectile function in most patients [14,21,22]. The multi-institutional experience we present reveals a limited failure rate (9.35%) that is very comparable to intrasphincteric anastomotic urethroplasty after BPO surgery (3.9-10%) [17,23].…”

Section: Discussionmentioning

confidence: 54%

“…The risks of recurrence and of de novo incontinence increase to 28.9% and 10.5%, respectively, when a bulbomembranous ventral onlay graft is performed after radiation [29]. In this sense, a recent multi-institutional assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis revealed a 17.7% risk of recurrence and an 8.1% risk of de novo incontinence [21].…”

Section: Discussionmentioning

confidence: 99%

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Multi-Institutional Study of Dorsal Onlay Urethroplasty of the Membranous Urethra after Endoscopic Prostate Procedures: Operative Results, Continence, Erectile Function and Patient Reported Outcomes

Angulo

Dorado

Policastro

et al. 2021

JCM

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(1) Background: To critically evaluate dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for posterior urethral stenosis repair following transurethral resection and other endoscopic prostate procedures. (2) Methods: A retrospective multi-institutional review of patients with membranous or bulbomembranous urethral stenosis for whom treatment with DOBMGU was conducted after receipt of prostate endoscopic procedures. Baseline data, peri-operative care, post-operative care and patient-reported outcomes were analyzed. The primary outcomes were procedural failure and development of de novo stress urinary incontinence (SUI). The secondary outcomes were changes in voiding, sexual function and patient satisfaction. (3) Results: A total of 107 men with a mean age of 69 ± 9.5 years and stenosis length of 3.5 ± 1.8 cm were included. Prior endoscopic procedures among participants were 47 patients (44%) with monopolar TURP, 33 (30.8%) with bipolar TURP, 16 (15%) with Greenlight laser, 9 (8.4%) with Holmium laser enucleation and 2 (1.9%) with bladder neck incision. At a mean follow-up time of 59.3 ± 45.1 months, stenosis recurred in 10 patients (9.35%). Multivariate analysis confirmed that postoperative complications (OR 12.5; p = 0.009), history of radiation (OR 8.3; p = 0.016) and ≥2 dilatations before urethroplasty (OR 8.3; p = 0.032) were independent predictors of recurrence. Only one patient (0.9%) developed de novo SUI. Patients experienced significant improvement in PVR (128 to 60 cc; p = 0.001), Uroflow (6.2 to 16.8 cc/s; p = 0.001), SHIM (11.5 to 11.7; p = 0.028), IPSS (20 to 7.7; p < 0.001) and QoL (4.4 to 1.7; p < 0.001), and 87 cases (81.3%) reported a GRA of + 2 or better. (4) Conclusions: DOBMGU is an effective and safe option for patients with posterior urethral stenosis following TURP and other prostate endoscopic procedures. This non-transecting approach minimizes external urinary sphincter manipulation, thus limiting postoperative risk of SUI or erectile dysfunction.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Multi-Institutional Study of Dorsal Onlay Urethroplasty of the Membranous Urethra after Endoscopic Prostate Procedures: Operative Results, Continence, Erectile Function and Patient Reported Outcomes

Angulo

Dorado

Policastro

et al. 2021

JCM

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“…Comparing our operative time with other posterior urethral stricture repairs shows that for a large contemporary multiinstitutional series on posterior EPA, the mean operative time was 176 minutes, and the median was 150 (1). For a similar multi-institutional series for dorsal onlay BMGU the median operative time was 184 minutes (12). Whereas the robotic deep urethroplasty has a mean operative time of 240 minutes (2).…”

Section: Discussionmentioning

confidence: 82%

Simplified posterior urethroplasty utilizing laparoscopic instrumentation

Balzano¹,

Abramowitz²,

Sam³

et al. 2021

Transl Androl Urol

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“…RT also produces an accumulation of free radicals and ROS responsible for continuing fibrosis [ 48 ]. This progressive tissue scarring will lead to late development of post-RT urethral stenosis, most of which occur up to 3 years after radiotherapy ( Figure 1 ) [ 20 , 49 , 50 , 51 ].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Historically, due to these challenges and the likelihood of rabdosphincter involvement, men with RT-induced BMUS have long been regarded less than ideal candidates for urethroplasty and have received urinary diversion if endoluminal modalities failed or were unfeasible. Patency rates of 67% to 95% have been reported for EPA and 50% to 83% for BMG urethroplasty in irradiated patients, with FU ranging from 21 to 66 months [ 49 , 50 , 51 , 100 , 101 , 102 ]. The continence rates with BMUS urethroplasty, and eventually resection of the rabdosphincter, compared favorably to VUAS reconstruction, likely reflecting an intact bladder neck after RT.…”

Section: Managementmentioning

confidence: 99%

Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life

Martins

Holm

Lumen

2021

JCM

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Bladder outlet obstruction following treatment of pelvic cancer, predominantly prostate cancer, occurs in 1–8% of patients. The high incidence of prostate cancer combined with the long-life expectancy after treatment has increased concerns with cancer survivorship care. However, despite increased oncological cure rates, these adverse events do occur, compromising patients’ quality of life. Non-traumatic obstruction of the posterior urethra and bladder neck include membranous and prostatic urethral stenosis and bladder neck stenosis (also known as contracture). The devastated bladder outlet can result from benign conditions, such as neurogenic dysfunction, trauma, iatrogenic causes, or more frequently from complications of oncologic treatment, such as prostate, bladder and rectum. Most posterior urethral stenoses may respond to endoluminal treatments such as dilatation, direct vision internal urethrotomy, and occasionally urethral stents. Although surgical reconstruction offers the best chance of durable success, these reconstructive options are fraught with severe complications and, therefore, are far from being ideal. In patients with prior RT, failed reconstruction, densely fibrotic and/or necrotic and calcified posterior urethra, refractory incontinence or severe comorbidities, reconstruction may not be either feasible or recommended. In these cases, urinary diversion with or without cystectomy is usually required. This review aims to discuss the diagnostic evaluation and treatment options for patients with bladder outlet obstruction with a special emphasis on patients unsuitable for reconstruction of the posterior urethra and requiring urinary diversion.

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A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis

Cited by 19 publications

References 31 publications

Multi-Institutional Study of Dorsal Onlay Urethroplasty of the Membranous Urethra after Endoscopic Prostate Procedures: Operative Results, Continence, Erectile Function and Patient Reported Outcomes

Multi-Institutional Study of Dorsal Onlay Urethroplasty of the Membranous Urethra after Endoscopic Prostate Procedures: Operative Results, Continence, Erectile Function and Patient Reported Outcomes

Simplified posterior urethroplasty utilizing laparoscopic instrumentation

Devastated Bladder Outlet in Pelvic Cancer Survivors: Issues on Surgical Reconstruction and Quality of Life

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