Long-term outcomes of anastomotic urethroplasty for radiation-induced strictures

Keith, Christopher G.; Davenport, M.; Kavoussi, Mehraban; Yi, Ya Sha; Bergeson, Rachel; Morey, Allen F.

doi:10.1007/s00345-019-03028-7

Cited by 15 publications

(11 citation statements)

References 21 publications

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“…[8][9][10] This series also compares favorably with the 70%-91% success rates of other series describing anastomotic urethroplasty for radiotherapy-induced urethral strictures. [5][6][7]11,12 While with any urethroplasty technique there can be a progressive rate of stricture recurrence over time, our mean follow-up of 32.3 months provides some evidence of procedural durability. 12 Our series complements these publications as the largest described series of urethroplasty for radiation induced urethral stenosis.…”

Section: Discussionmentioning

confidence: 83%

“…Anecdotally, recurrent radiation stenosis after urethroplasty may be amenable to endoscopic procedures than the pre-operative state due to a reduction in fibrosis compared to the pre-operative state. 7 The majority of patients in our study required adjunctive surgical maneuvers beyond a standard anastomotic urethroplasty. These maneuvers included, corporal splitting (71.5%), partial prostatectomy (37.2%), partial pubectomy (12.4%) and gracilis muscle flap (23.4%).…”

Section: Discussionmentioning

confidence: 96%

“…3 While the urethroplasty experience in this setting remains limited, excision and primary anastomosis (EPA) is the most commonly utilized technique. [5][6][7] This surgical preference is likely related to several factors including potential impairment of graft take due to a diseased peri-urethral milieu after radiation, often short stenosis length and challenging location deep within the male pelvis. We present a multicenter retrospective review of outcomes following EPA for radiotherapy-associated urethral strictures following prostate cancer treatment.…”

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confidence: 99%

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Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment

Voelzke

Leddy

Myers

et al. 2021

Urology

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for the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) OBJECTIVETo evaluate the outcomes of excision and primary anastomosis (EPA) for radiation-associated bulbomembranous stenoses using a multi-institutional analysis. The treatment of radiation-associated urethral stenosis is typically complex owing to the adverse impact of radiation on adjacent tissue. METHODSAn IRB-approved multi-institutional retrospective review was performed on patients who underwent EPA for bulbomembranous urethral stenosis following prostate radiotherapy. Preoperative patient demographics, operative technique, and postoperative outcomes were abstracted from 1/ 2007−6/2018. Success was defined as voiding per urethra without the need for endoscopic treatment and a minimum follow-up of 12 months. RESULTSOne hundred and thirty-seven patients from 10 centers met study criteria with a mean age of 69.3 years (50-86), stenosis length of 2.3 cm (1-5) and an 86.9% (119/137) success rate at a mean follow-up 32.3 months (12-118). Univariate Cox regression analysis identified increasing patient age (P = .02), stricture length (P <.0001) and combined modality radiotherapy (P = .004) as factors associated with stricture recurrence while body mass index (P = .79), diabetes (P = .93), smoking (P = .62), failed endoscopic treatment (P = .08) and gracilis muscle use (P = .25) were not. On multivariate analysis, increasing patient age (H.R.1.09, 95%CI 1.01-1.16; P = .02) and stenosis length (H.R.2.62, 95%CI 1.49-4.60; P = .001) remained associated with recurrence. Subsequent artificial urinary sphincter was performed in 30 men (21.9%), of which 25 required a transcorporal cuff and 5 developed cuff erosion. CONCLUSIONSEPA for radiation-associated urethral stenosis effectively provides unobstructed instrumentationfree voiding. However, increasing stenosis length and age are independently associated with surgical failure. Patients should be counseled that further surgery for incontinence may be necessary.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

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Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment

Voelzke

Leddy

Myers

et al. 2021

Urology

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“…Detailed screening procedure is displayed in the Fig. 1.There were 9 studies (total 2279 patients) contained smokingstricture recurrence univariate analysis information [3,[8][9][10][11][12][13][14][15], 7 studies (total 2074 patients) contained multivariable analysis information [6, 7, 11-13, 16, 17]. Out of 12 involved studies, 11 studies are retrospective cohort studies and only 1 study was prospectively designed.…”

Section: Results 21 Study Selectionmentioning

confidence: 99%

“…As one of the main methods to treat urethral stricture, there are many ways to implement urethroplasty, including primary anastomosis and substitution implantation. However, although many different surgical methods have been developed for different stricture degree, length and location, the total success rate is still only 72% − 94% [11,14,16]. Therefore, it is very important to find out the risk factors of recurrence of urethral stricture after urethroplasty and to prevent them.…”

Section: Discussionmentioning

confidence: 99%

Is There a Relationship Between Smoking and Stricture Recurrence After the Urethroplasty? a Systematic Review and Meta-Analysis

Wang

Jian

et al. 2020

Preprint

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Background Some retrospective studies have noted that smoking is a possible risk factor for recurrence of restenosis after urethroplasty, but not all of them are consistent. Therefore a meta-analysis is needed. Method Pubmed, Web of Science, Embase, Cochrane databases were searched with key words: “urethroplasty”, “buccal mucosa graft urethroplasty”, “oral mucosa graft urethroplasty”, “excision and primary anastomosis urethroplasty”, “urethral stricture recurrence” until Jan 30, 2020. The quality of included studies was assessed by Newcastle-Ottawa Scale (NOS) system. Hazard ratio (HR), odds ratio (OR), relative risk (RR) with 95% confidence interval (CI) were extracted or re-calculated from included studies. Meta-analysis was performed with Stata 15.0 based on univariate and multivariate data separately. Sensitivity analysis was performed to test stability of meta-analysis. I 2 was calculated to evaluate heterogeneity. Publication biases were assessed by egger’s and begg’s tests. Funnel plots of univariate analysis and multivariate analysis were also offered. Results 12 studies with 3443 patients were involved into this meta-analysis. The analysis results of two stages were consistent. In the univariate meta-analysis stage, 9 studies with 2279 patients were pooled and the result indicated that smoking might promote stricture recurrence (RR=1.46, 95%CI: 1.11-1.93, P=0.008). In the multivariate meta-analysis stage, based on adjusted estimate, 7 studies with 2074 patients were pooled and the result indicated that smoking might promote stricture recurrence (RR=1.39, 95%CI: 1.04-1.85, P=0.026). There was no significant heterogeneity in both univariate and multivariate stage. Conclusion This meta-analysis of current evidence indicates that smoking may prompt stricture recurrence after the urethroplasty. Quitting smoking may be a good option for patients undergoing urethroplasty surgery.

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

et al. 2020

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Long-term outcomes of anastomotic urethroplasty for radiation-induced strictures

Cited by 15 publications

References 21 publications

Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment

Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment

Is There a Relationship Between Smoking and Stricture Recurrence After the Urethroplasty? a Systematic Review and Meta-Analysis

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

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