Elsevier

Urology

Volume 85, Issue 1, January 2015, Pages 258-262
Urology

Reconstructive Urology
Long-term Outcomes of Urethroplasty With Abdominal Wall Skin Grafts

https://doi.org/10.1016/j.urology.2014.08.055Get rights and content

Objective

To report the long-term outcomes of urethroplasty using abdominal wall skin (AWS) grafts. Men with long-segment strictures, prior urethroplasty, and lichen sclerosus (LS) pose challenges in surgical management, including the choice of graft tissue for urethral reconstruction. AWS grafts are an alternative when buccal mucosa or penile grafts are not feasible or chosen by the patient.

Methods

We retrospectively reviewed 238 patients who underwent urethroplasty (2000-2010) with at least 1 year of follow-up. Demographics, etiology, comorbidities, prior procedures, and surgical technique were analyzed for correlation with recurrence.

Results

Mean age was 42.9 years (range, 15-79 years), mean stricture length 5.6 cm (1-24 cm), and median follow-up of 59.3 months (12.5-147 months). A total of 58.4% patients had prior intervention, of which 15 patients (6.3%) had urethroplasty and 41 patients (17.2%) had hypospadias repair. Twenty-six patients (10.9%) underwent urethroplasty with AWS graft, whereas 107 (45.0%) and 12 (5.0%) patients were augmented with buccal mucosa or genital skin. Sixty-six patients (27.7%) had stricture recurrence at a mean of 34.5 months (range, 1.87-87.1 months). On univariate analysis, patients with AWS graft had longer strictures (P = .0001), were more likely to have LS (P = .0002), prior urethroplasty (P = .007), and recurrence (P = .002). On multivariate analysis, prior urethroplasty (odds ratio [OR], 5.3; P = .009), diabetes (OR, 2.6; P = .04), and LS (OR, 2.8; P = .05) were significantly associated with recurrence, whereas AWS graft was not (OR, 2.0; P = .28).

Conclusion

AWS grafts are an alternative tissue source for urethral stricture, but may be associated with greater risk of recurrence. This may be secondary to patient selection, with this population often having other risk factors for recurrence.

Section snippets

Methods

We performed an institutional review board–approved retrospective study of 291 patients who underwent urethroplasty at a single institution between 2000 and 2010 with at least 1 year of documented follow-up. Patients with incomplete operative or outcomes data, or lack of assessment of voiding symptoms at least 1 year postoperatively were excluded from analysis. The final study cohort included 238 patients. Patient data were retrospectively gathered from electronic medical records. Demographic

Results

A total of 238 men with an average age of 42.9 years (range, 15-79 years) underwent urethroplasty for urethral stricture with a mean length of 5.6 cm (range, 1-24 cm), and a median follow-up of 59.3 months (range, 12.5-147 months). The urethral stricture locations are described in Table 1. A total of 58.4% patients had undergone prior intervention for stricture (ie, dilation, internal urethrotomy, and urethroplasty), of which 15 patients (6.3%) had failed prior urethroplasty, and 41 patients

Comment

Buccal mucosa harvest is the most common graft tissue used for urethral reconstruction but may be limited in the amount of graft tissue available for extensive strictures.6 Barbagli et al9 reported a maximum graft area of 4 cm in length and 2.5 cm in width from each cheek to minimize complications. Reported complications from oral mucosa harvest include pain, perioral numbness, tightness of the mouth, motor deficits, and long-term speech morbidity (lingual mucosa grafts exceeding 7 cm).7 The

Conclusion

AWS grafts are an alternative graft source for men with extensive or recurrent urethral stricture, with advantages of a large continuous area of graft, limited donor site morbidity, extragenital origin of the skin, and avoidance of extensive oral mucosal harvest. Although AWS graft remains an option in these patients, it may be associated with a higher recurrence risk than other types of repair. However, these data may be reflective of the patient cohort requiring AWS, with this population

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  • Surgical Approaches and Long-Term Outcomes in Adults with Complex Reoperative Hypospadias Repair

    2018, Journal of Urology
    Citation Excerpt :

    All 4 patients in whom stricture recurred had a skin graft. A study by Liu et al from our institution provided long-term outcomes of urethroplasty with abdominal wall skin grafts.11 Univariate analysis demonstrated that abdominal wall skin grafts were associated with recurrent stricture but this did not hold on multivariate analysis.

  • Use of a fibrovascular tube in creation of neo-urethra during penile reconstruction

    2017, Journal of Pediatric Urology
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    Buccal mucosa grafts have important rates of fistula formation, stricture, and meatal stenosis, [26]. Skin grafts tend to contract and have poor elasticity, incompatible with erectile function, and also carry the risk of a hairy urethra, even if harvested from an apparently non-hairy area [27,28]. The vein can be used either directly or after evertion inside-out as a substitute for urethral reconstruction [29], but the existence of the valve inside the venous lumen and donor site morbidity may have a negative effect for urethral reconstruction using vein grafts.

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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