Standing the test of time: the long-term results of urethroplasty

Abstract

The principle indication for urethral surgery is stricture disease. There are a number of factors that influence the outcome of surgery including location of the stricture, stricture length, aetiology, previous surgery and selection of procedure. Outcomes for different techniques are summarised. The gold standard remains anastomotic urethroplasty, where appropriate, with patch urethroplasty or two-stage stage procedures for more complicated strictures especially the penile urethra.

Urethroplasty for failed hypospadias repair: A matched cohort analysis

“…A urethroplasty after failed hypospadias repair can thus be considered as a revision urethroplasty. Worse outcomes after previously failed urethroplasty have been reported [14,15]. Possible explanations for this are: 1) the urethra cannot be elongated twice, thus jeopardising an anastomotic repair in revision urethroplasty; 2) former use of skin flaps makes the use of pedicled flap urethroplasty difficult and more hazardous; 3) moreover, fibrotic tissue due to previous surgery, or to the hypospadias itself, can make any kind of urethroplasty more difficult.…”

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

“…5,6 Despite this, longterm follow-up shows failures do occur in 2% to 30% of patients depending on the type of urethroplasty employed. 7,8 Therefore, "What factors are associated with stricture recurrence?" remains an important question.…”

Evaluation and Treatment of Urethral Stricture Disease

“…During the past 15 years, two-stage free graft urethroplasty with buccal mucosa has been adopted by many experts in the field [53]. Although success rates vary, the restricture rate at 3 years is similar for one-and two-stage repairs (13%-30%) [47]. Although some one-stage flap repairs (Orandi procedure) are still used, many believe that excision of the diseased urethral plate with buccal mucosal onlay with a secondstage circumferential retubularization 6 months later is the safest means to repair penile strictures.…”

“…Although the traditional extent of primary anastomotic urethroplasty has been 2 cm, some experts have successfully repaired up to 5-cm defects with this approach [48]. Overall, the success rate from several series for bulbar end-to-end anastomotic urethroplasty is 90%-98% using different follow-up criteria [47][48][49][50].…”

“…Anastomotic urethroplasty demonstrates the best chance for long-term success with the lowest complication rates and should be used when possible [46]. Compared with anastomotic urethroplasty, the success of substitution urethroplasty can decline with time [47]. The two main factors, location and length, inevitably influence the reconstructive urologist's decision as to which type of urethroplasty to perform.…”