Complicated urethroplasty: a guide for surgeons

Burks, Frank; Santucci, Richard A.

doi:10.1038/nrurol.2010.118

Cited by 14 publications

(7 citation statements)

References 33 publications

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“…13 The increased likelihood of urethroplasty failure and the reconstructive challenge presented by men with prior failed hypospadias repair, radiation therapy and lichen sclerosis is well recognized 6,14,15 and was confirmed in this study. We included men with these diagnoses in analysis to truly evaluate repeat urethroplasty success in those with recalcitrant stricture disease.…”

Section: Discussionsupporting

confidence: 72%

Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 Patients

et al. 2012

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Purpose Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment for urethral strictures, fewer studies have addressed the treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We examined outcome results for repeat urethroplasty. Materials and Methods A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with repeat urethroplasty after failed prior urethral reconstruction. Stricture length and location, and repeat urethroplasty intervention and failure were evaluated with descriptive statistics, and univariate and multivariate logistic regression. Results Of 1,156 cases 168 patients underwent repeat urethroplasty after at least 1 failed prior urethroplasty. Of these patients 130 had a followup of 6 months or more and were included in analysis. Median patient age was 44 years (range 11 to 75). Median followup was 55 months (range 6 months to 20.75 years). Overall, 102 of 130 patients (78%) were successfully treated. For patients with failure median time to failure was 17 months (range 7 months to 16.8 years). Two or more failed prior urethroplasties and comorbidities associated with urethral stricture disease were associated with an increased risk of repeat urethroplasty failure. Conclusions Repeat urethroplasty is a successful treatment option. Patients in whom treatment failed had longer strictures and more complex repairs.

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Section: Discussionsupporting

confidence: 72%

Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 Patients

et al. 2012

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“…The treatment options include dilation, direct visual internal urethrotomy, and urethroplasty. In general, urethroplasty is the most effective option for almost all strictures, and it is considered the gold standard for long, complex, or recurrent strictures [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Factors Predicting Urethral Stricture Recurrence after Dorsal Onlay Augmented, Buccal Mucosal Graft Urethroplasty

et al. 2020

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Introduction: This study was carried out to identify the predictors of urethral stricture recurrence after dorsal onlay buccal mucosal graft (BMG) urethroplasty. Materials and Methods: The medical records of patients with anterior urethral stricture who underwent dorsal onlay BMG urethroplasty at a single tertiary medical center during the period from March 2010 to January 2018 were reviewed. Only patients with ≥2-year follow-up were included. Data regarding patient demographics, clinical characteristics, stricture characteristics, postoperative course, and adverse events were recorded. Kaplan-Meier analysis was used to assess the recurrence-free survival and likelihood of stricture recurrence. Cox regression analysis was used to identify potential independent predictors of stricture recurrence. Results: This study included 266 patients with a mean age of 37.71 years and a mean follow-up period of 49.77 months. From the overall study cohort, 34 (12.8%) reported stricture recurrence and 232 (87.2%) were not. The mean recurrence-free time was 79.93 months and mean time to recurrence was 21.59 months. On multivariate analysis, obesity (hazard ratio (HR): 6.02; 95% conference interval (CI): 1.91, 19.03: p = 0.002), inflammatory aetiology (HR: 9.13; 95% CI: 3.50, 23.81; p < 0.001), prior urethroplasty (HR: 8.81; 95% CI: 3.26, 23.86; p < 0.001), penile stricture location (HR: 3.09; 95% CI: 1.10, 8.71; p = 0.033), and stricture length >4.5 cm (HR: 6.83; 95% CI: 1.69, 27.62; p = 0.007) were the significant independent predictors of stricture recurrence. Conclusions: Dorsal onlay BMG urethroplasty has a reasonable recurrence-free rate with acceptable postoperative complications. Obesity, inflammatory etiology, prior urethroplasty, penile stricture location, and longer stricture were the factors associated with urethral stricture recurrence.

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“…4 Among several treatment strategies, including dilation and direct visual internal urethrotomy (DVIU), urethroplasty has emerged as the cost-effective management option for almost all strictures and remains the gold standard for longer, complex or recalcitrant strictures. 5,6 Despite this, longterm follow-up shows failures do occur in 2% to 30% of patients depending on the type of urethroplasty employed. 7,8 Therefore, "What factors are associated with stricture recurrence?"…”

Section: Introductionmentioning

confidence: 99%

Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: A multivariate analysis of 604 urethroplasties

Kinnaird¹,

Levine²,

Ambati³

et al. 2014

CUAJ

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Introduction: We determine the preoperative identifiable risk factors during staging that predict stricture recurrence after urethroplasty. Methods: We conducted a retrospective review of all urethroplasties performed at a Canadian tertiary referral centre from 2003 to 2012. Failure was defined as a recurrent stricture <16 Fr on cystoscopic assessment. Multivariate analysis was calculated by Cox proportional hazard regression. Results: In total, 604 of 651 (93%) urethroplasties performed had adequate data with a mean follow-up of 52 months. Overall urethral patency was 90.7% with failures occurring between 2 weeks and 77 months postoperatively. The average time to recurrence was 11.7 months, with most patients with recurrence within 6 months (42/56; 75%). Multivariate regression identified Lichen sclerosus, iatrogenic, and infectious etiologies to be independently associated with stricture recurrence with hazard ratios (HR) (95% confidence interval) of 5.9 (2.1-16.5; p ≤ 0.001), 3.4 (1.2-10; p = 0.02), and 7.3 (2.3-23.7; p ≤ 0.001), respectively. Strictures ≥5cm recurred significantly more often (13.8% vs. 5.9%) with a HR 2.3 (1.2-4.5; p ≤ 0.01). Comorbidities, smoking, previous urethroplasty, stricture location and an age ≥50 were not associated with recurrence. Conclusion: Urethroplasty in general is an excellent treatment for urethral stricture with patency rates approaching 91%. While recurrences occur over 6 years after surgery, most (75%) recur within the first 6 months. Long segment strictures (≥5 cm), as well as Lichen sclerosus, infectious and iatrogenic etiologies, are associated with increased risk of recurrence. Limitations include the retrospective, single-centre nature of the study and the 7% loss to follow-up due to the centre being a regional referral one.

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Complicated urethroplasty: a guide for surgeons

Cited by 14 publications

References 33 publications

Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 Patients

Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 Patients

Factors Predicting Urethral Stricture Recurrence after Dorsal Onlay Augmented, Buccal Mucosal Graft Urethroplasty

Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: A multivariate analysis of 604 urethroplasties

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