Long term outcomes of one-stage augmentation anterior urethroplasty: a systematic review and meta-analysis

Abstract

Objective: The objective is to summarize and characterize the long-term success of anterior augmentation urethroplasty (AU) in published series. The current literature on AU consists largely of retrospective series reporting intermediate follow-up and incompletely characterize the long term outcomes of AU. Materials and Methods: A systematic literature review was performed consistent with PRISMA guidelines to characterize long-term outcomes of AU with a minimum upper limit follow-up of 100 months. Penile/preputial skin flaps and graft and oral mucosal graft urethroplasties were included. The primary outcome was stricture-free survival for one-stage AU. Secondary analysis evaluated differences in outcomes based on two failure definitions: the need for intervention versus presence of recurrent stricture on cystoscopy or urethrography. Hazard rates were induced from the reported failure rates of one-stage AU and fixed and random effect models were fitted to the data. Additional subset analysis, removing potential confounders (lichen sclerosus, hypospadias and penile skin graft), was performed. Results: Ten studies met inclusion criteria, and two studies reported separate outcomes for grafts and flaps, and thus were included separately in the analysis. The mean hazard rate across all studies was 0.0044, the corresponding survival rates at 1 year 0.948, 5 years 0.766, 10 years 0.587, and 15 years 0.45. Subset analysis of the 4 select and homogeneous studies noted 1, 5, 10, and 15 years survival rates of 0.97, 0.96, 0.74, and 0.63, respectively. Conclusions: The long-term success rates of augmentation urethroplasty are appear to be worse than previously appreciated and patients should be counseled accordingly.

Oral Mucosa vs. Penile Skin Flap in Substitution Urethroplasty for Anterior Urethral Strictures: A Systematic Review and Meta-Analysis

“…After careful searching and reviewing, 1,175 studies were identified from the database searches. After the screening procedures and quality evaluations were applied, the original data extracted from eight studies ( 13 – 20 ) were included in the quantitative analysis. Figure 1 shows the screening flow chart.…”

“…We noticed that there was a previously published meta-analysis which also meant to evaluate penile skin flaps in the urethroplasty, however, that meta-analysis was based on the estimates calculated from Cox regression from retrospective studies, not comparison data, which may decrease the level of evidence ( 13 ). Therefore, the purpose of this study is to compare two different substitution techniques based on existing published comparison literatures.…”

Does successful urethral calibration rule out significant female urethral stenosis? confronting the confounder- an outcome analysis of successfully treated female urethral strictures

“…Also, recurrent dilation can act as a double-edged sword to further complicate this already complex pathology. Like in male urethral strictures, even in female urethral strictures, many techniques of dorsal and ventral graft/fl ap urethroplasties have been described (27,28). However, which technique is to be chosen and when is not yet standardized.…”

Multi‐institutional review of non‐hypospadiac penile urethral stricture management and outcomes

“…Many studies include patients with hypospadias in their cohorts, which is a completely different pathophysiology, being a congenital deficiency in urethral tissue as opposed to scarring of a normal urethra. [8][9][10] In addition, many approaches to the repair of a penile urethral stricture have been described. [11][12][13][14][15][16] Few studies have analyzed penile strictures after excluding hypospadias and glans-limited disease.…”