Multi-institutional 1-Year Bulbar Urethroplasty Outcomes Using a Standardized Prospective Cystoscopic Follow-up Protocol

Abstract

OBJECTIVE To evaluate multi-institutional outcomes of bulbar urethroplasty utilizing a standardized cystoscopic follow-up protocol. METHODS Eight reconstructive surgeons prospectively enrolled urethral stricture patients in a multi-institutional study and performed postoperative cystoscopy at 3 and 12 months. Anatomic failure was defined as the inability to pass a flexible cystoscope without force. Functional failure was defined as the need for a secondary procedure. Men not compliant with the 12-month cystoscopy were called and asked if any interval secondary procedures had been performed. Patients with bothersome voiding complaints at cystoscopy were considered symptomatic. RESULTS Of 213 men in study, 136 underwent excisional urethroplasty (excision and primary anastomosis [EPA]) and 77 underwent repair with buccal grafts. Cystoscopy compliance was 79.8% at 3 months and 54.4% at 12 months. Anatomic success rates were higher at 3 vs 12 months for EPA repairs (97.2% [106 of 109] vs 85.5% [65 of 76; P = .003] but not buccal repairs (85.5% [53 of 62] vs 77.5% [31 of 40]; P = .30). Functional success rates at a year were higher but statistically similar to anatomical success rates (EPA—90.3% [93 of 103]; P = .33; buccal—87% [47 of 54]; P = .22). Of the 20 anatomic recurrences, only 13 (65%) were symptomatic at the time of cystoscopic diagnosis. CONCLUSION Rates of success are lower when using the anatomic vs traditional definition. Of recurrences found by cystoscopy, only 65% were symptomatic. One-year patient cystoscopy compliance was poor and its ability to be used as the gold standard screening methodology for recurrence is questionable.

Assessment of the Male Urethral Reconstruction Learning Curve

“…Institutional review board approval was obtained for this study at each site. All patients who had their urethroplasty performed after June of 2009 were enrolled in a TURNS-specific follow-up protocol described previously 11 .…”

Endoscopic Treatment of Vesicourethral Stenosis after Radical Prostatectomy: Outcomes and Predictors of Success

“…Furthermore, average routine follow-up with cystoscopy was less than 1 year, and we therefore cannot comment on long-term success rates for these endoscopic treatments. However, assessment for recurrent stricture using cystoscopy may be the most sensitive detection method for VUS and may precede other measures such as recurrent voiding symptoms, urinary tract infection or the need for further intervention 16,25 . Though findings from other studies have found no significant change in existing voiding symptoms or incontinence rates after endoscopic treatment for VUS, we could not comment on these parameters in our study 1,3,12 .…”

Nontransecting Anastomotic Repair in Urethral Reconstruction: Surgical and Functional Outcomes

“…Patients were not systematically evaluated postoperatively by urethroscopy or urethrography but only if clinically indicated. As a consequence, some low-grade recurrences can have been missed 23 . This is a case series of NTAR only and as a consequence any comparison with TAR or any other type of urethroplasty must be done with caution because of risk of confounding factors.…”