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

Abstract

<b><i>Introduction:</i></b> This study was carried out to identify the predictors of urethral stricture recurrence after dorsal onlay buccal mucosal graft (BMG) urethroplasty. <b><i>Materials and Methods:</i></b> 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. <b><i>Results:</i></b> 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: <i>p</i> = 0.002), inflammatory aetiology (HR: 9.13; 95% CI: 3.50, 23.81; <i>p</i> < 0.001), prior urethroplasty (HR: 8.81; 95% CI: 3.26, 23.86; <i>p</i> < 0.001), penile stricture location (HR: 3.09; 95% CI: 1.10, 8.71; <i>p</i> = 0.033), and stricture length >4.5 cm (HR: 6.83; 95% CI: 1.69, 27.62; <i>p</i> = 0.007) were the significant independent predictors of stricture recurrence. <b><i>Conclusions:</i></b> 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.

Onlay Pedicled Transverse Skin Flap versus One-Stage Inlay Buccal Mucosal Graft in Penile Urethroplasty: A Prospective Matched-Pair Analysis

“…As our study cohort is rather small, however, and as there were solely 3 patients (6.8%) who had received a prior urethral dilation, we certainly refrain from drawing any definitive conclusions. The risk factors most commonly described by previous series (age, stricture length, body mass index [24][25][26]) were not found to be statistically significant in our analysis.…”

“…With regard to risk factors for stricture recurrence, the only statistically significant association we found was that patients who had received a prior urethral dilation, when compared to patients with no previous surgery or previous VIU, were less likely to develop a stricture recurrence (p = 0.018). As this association has not yet been reported by previous series [1,[12][13][14][15][24][25][26], we have to assume it is a statistically significant effect without clinical relevance. As our study cohort is rather small, however, and as there were solely 3 patients (6.8%) who had received a prior urethral dilation, we certainly refrain from drawing any definitive conclusions.…”

Comparative evaluation of 90-day patient outcomes and healthcare encounters following extended day surgery urethroplasty

“…Previous studies have identified inflammatory strictures as a risk factors for urethroplasty failure; specifically, the presence of lichen sclerosus portends a poorer prognosis overall, and has been clearly identified as an independent predictor of stricture recurrence. 8,9 While the exact mechanism remains unclear, it is thought that chronic localized inflammation leads to alterations…”

Dorsal Onlay Urethroplasty Using Buccal Mucosal Graft and Vaginal Wall Graft for Female Urethral Stricture; Outcome of a Tertiary Care Hospital

“…The buccal mucosal grafting is advantageous over VWG due to the narrowing of the vagina, but VWG has the advantage in case of patients having unhygienic conditions, smoking, and some oral infections. In the case of VWG, local anesthesia was given to the patients, but in some cases, general anesthesia also needed to be utilized [21][22] .…”