Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 Patients

Abstract

Purpose Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment for urethral strictures, fewer studies have addressed the treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We examined outcome results for repeat urethroplasty. Materials and Methods A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with repeat urethroplasty after failed prior urethral reconstruction. Stricture length and location, and repeat urethroplasty intervention and failure were evaluated with descriptive statistics, and univariate and multivariate logistic regression. Results Of 1,156 cases 168 patients underwent repeat urethroplasty after at least 1 failed prior urethroplasty. Of these patients 130 had a followup of 6 months or more and were included in analysis. Median patient age was 44 years (range 11 to 75). Median followup was 55 months (range 6 months to 20.75 years). Overall, 102 of 130 patients (78%) were successfully treated. For patients with failure median time to failure was 17 months (range 7 months to 16.8 years). Two or more failed prior urethroplasties and comorbidities associated with urethral stricture disease were associated with an increased risk of repeat urethroplasty failure. Conclusions Repeat urethroplasty is a successful treatment option. Patients in whom treatment failed had longer strictures and more complex repairs.

Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: A multivariate analysis of 604 urethroplasties

“…18 Repeat urethroplasty is a viable option for stricture recurrence. 15 In the 20% of our urethroplasties having undergone previous repair, we found that previous urethroplasty does not contribute to treatment failure.…”

“…Lichen sclerosus has been implicated with failure after repeat urethroplasty; we believe that the reason for recurrence is that the underlying disease has not been adequately treated such that it is not truly treatment failure, but rather disease progression as part of the natural history of Lichen sclerosus. 15,16 Infectious etiology is another risk factor for recurrence. These strictures are secondary to Reiter's syndrome or Fournier's gangrene where significant tissue inflammation and necrosis may occur.…”

Male urethral strictures and their management

“…69–72 Studies have also shown excellent success rates for redo urethroplasty (78% in one large series). 73 Predictors of failure following repeat urethroplasty include a history of hypospadias repair, lichen sclerosis, and a history of two or more failed prior urethroplasties. 74 …”

Salvage Surgery after Failure of Urethroplasty for Stricture Disease

“…These outcomes are similar to those in previous reports of the success of salvage EPA for bulbar recurrences. 5 It is important to note that in the series by Siegel et al the cohort of men undergoing salvage EPA was selective and limited to those with relatively short segment bulbar disease without more complex urethral pathology caused by LS, previous pelvic radiation treatment, pelvic fracture related urethral injury or previous hypospadias surgery. 9 In patients with complex urethral pathology and stricture recurrence a thoughtful approach toward surgical management is needed as many have deficient and diseased genital skin, extensive scar tissue, obliterated tissue planes and a tenuous urethral blood supply.…”

“…Despite the risk of reconstructive failure in these patients salvage urethroplasty in experienced hands offers recurrence-free outcomes (defined as no further need for postoperative instrumentation) as high as 79% along with significant improvement in patient reported satisfaction with surgery and quality of life. 5,10 Penile urethroplasty carries a higher risk of recurrent stricture than bulbar urethroplasty in primary and salvage cases. 1,10 Many men with a recurrent stricture after urethroplasty have significant genital skin deficiency, a lengthy stricture, LS or severe spongiofibrosis.…”