Long-Term Followup and Deterioration Rate of Anterior Substitution Urethroplasty

Abstract

Deterioration after anterior 1-stage substitution urethroplasty seems to develop within the first 5 years. Oral mucosa showed greater failure-free survival than penile skin and 1-stage penile urethroplasty showed the same success rate as bulbar urethroplasty.

Editorial Comment from Dr Rourke to Risk of urethral stricture recurrence increases over time after urethroplasty

“…4 The recurrence rate according to Andrich et al also appears to be stable at 5, 10 and 15 years after anastomotic urethroplasty. 5 In accordance with the authors' findings, I suppose these differences might be due to the number of patients who did not participate in follow-up examinations and could have experienced recurrences. Patients should be carefully monitored continually after urethroplasty irrespective of the type of procedure carried out, and surveillance protocols should be standardized.…”

“…Other occasionally identified factors include diabetes, the use of penile skin grafts, surgical technique (anastomotic urethroplasty), hypospadias, poor oral hygiene and surgeon experience. 5,6 Some of the inconsistency can be explained by the fact that no studies have examined a comprehensive list of all known potential confounding variables, which increases the risk of underestimating or overestimating the association between a given variable and treatment outcome. Additionally, many studies are simply not statistically powered to examine all potential risk factors, and a significant association with more factors might have been found if studies had greater statistical power.…”

“…[3][4][5] Lifelong follow up is necessary after substitution urethroplasty, because stricture recurrences can increase with time and occur even after 15 years as a result of the contracture of grafts or flaps.…”

Comparison of Heineke Mikulicz Stricturoplasty and End to End Anastomotic Urethroplasty Techniques for Short Bulbar Urethral Strictures

“…16,17 Bulbar darlıklarda EPA'nın başarı oranı diğer bulbar üretroplasti yöntemlerine göre daha yüksek-tir. 18,19 Fakat son zamanlarda, üretranın transeksiyonunun üretral kan dolaşımını olumsuz etkileyebileceği ve üretra iskemisine ve cinsel yan etkilere neden olacağına dair artan endişeler mevcuttur. 9,[20][21][22][23] Bu yüzden transeksiyonsuz yaklaşımlar tanımlan-mıştır.…”

Flexible Cystourethroscopy in the Follow-up of Posturethroplasty Patients and Characterisation of Recurrences

“…The pragmatic definition of procedural outcome is based on the need for further intervention [27]. Clearly, the success rate of urethroplasty will be dependent on the functional definition of success that is used.…”