Reconstructive UrologyA Multi-institutional Evaluation of the Management and Outcomes of Long-segment Urethral Strictures
Section snippets
Methods
After obtaining institutional review board approval, a retrospective, international, multi-institutional review was performed of patients who were treated with at least 1 urethroplasty for a nonobliterated stricture ≥8 cm with at least 1 year of follow-up and with known recurrence status. Exclusion criteria included obliterative strictures, a stricture treated with an anastomotic urethroplasty (in an augmented fashion), scrotal skin, smooth intestine submucosa augmentation, or a history of
Results
Four hundred eighty-two patients were evaluated from December 1984 to November 2013. Four hundred sixty-six patients met inclusion criteria for analysis. Of the excluded patients, 3 had small intestine submucosal augments, 8 had an augmented anastomotic urethroplasty, 1 had previous radiation, 1 was treated with scrotal skin, and finally 3 had no available information regarding recurrence status.
Mean age was 51.3 years (range, 16-82 years); average follow-up was 20 months (range, 12-344
Comment
This study has several important findings that are readily applicable for reconstructive urologists.
- (1)
Ventral or dorsal buccal mucosal urethroplasty appears more successful than the 2-stage Johanson urethroplasty (18% failure vs 36% failure, respectively; odds ratio, 2.87).
- (2)
BMG, when used in LS patients treated with 2-stage Johanson urethroplasty, resulted in far fewer recurrences than when BMG is not used (14% recurrence rate vs 48%, respectively). BMG was also superior to skin grafts (16% vs
Conclusion
One-stage repairs with BMG offer an excellent option for patients with long segment and panurethral stricture disease. In cases with obliterative or absent urethral plate, a 2-stage Johanson urethroplasty with BMG offers a viable alternative. In cases of LS, 1-stage BMG has better outcomes than a 2-stage repair. If BMGs are not available, FC flaps offer similar success; however, these are associated with higher rates of complications. Skin grafts should be avoided, unless no alternatives exist.
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Cited by (44)
Buccal mucosa graft urethroplasty for bulbar urethral stricture: Outcomes and predictive factors affecting success
2023, Actas Urologicas EspanolasNew frontiers in urethral reconstructive surgery
2022, Scientific Advances in Reconstructive Urology and Tissue EngineeringEuropean Association of Urology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease[Formula presented]
2021, European UrologyCitation Excerpt :In addition, 19% of men required a revision of their first-stage urethroplasty [54]. The options for surgical reconstruction are various and often include combinations of different techniques or grafts (Table 6) other than oral mucosa graft (OMG) [53]. The patency rates are usually lower than in shorter reconstructions (Supplementary Table 4).
Financial Disclosure: Kenneth W. Angermeier is a paid consultant to American Medical Systems. The remaining authors declare that they have no relevant financial interests.