199 REPEATED ENDOSCOPIC TREATMENT OF BULBAR URETHRAL STRICTURES IS ASSOCIATED WITH INCREASED STRICTURE COMPLEXITY AND DURATION OF SYMPTOMS

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery1 Apr 2011199 REPEATED ENDOSCOPIC TREATMENT OF BULBAR URETHRAL STRICTURES IS ASSOCIATED WITH INCREASED STRICTURE COMPLEXITY AND DURATION OF SYMPTOMS Steven Hudak, Celeste Valadez, Timothy Atkinson, and Allen Morey Steven HudakSteven Hudak Dallas, TX More articles by this author , Celeste ValadezCeleste Valadez Dallas, TX More articles by this author , Timothy AtkinsonTimothy Atkinson Dallas, TX More articles by this author , and Allen MoreyAllen Morey Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.270AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Men presenting for urethroplasty often have a longstanding history of failed visual urethrotomy and/or urethral dilation procedures. Previous studies have suggested that prior endoscopic treatment for urethral strictures is associated with an increased urethroplasty failure rate. We sought to further explore the impact of previous endoscopic treatment on the clinical course of men with bulbar urethral strictures, including stricture complexity and duration of symptoms. METHODS A retrospective review of 340 consecutive urethroplasties performed by a single surgeon between July 2007 and October 2010 was performed. Patients were divided into two groups based on endoscopic treatment history for urethral stricture disease at the time of urethroplasty (group 1: 0–1 treatment; group 2: ≥2 treatments). Only those with bulbar strictures were included, thus excluding those with pure penile and membranous strictures, as well as patients with a history of prior urethroplasty, hypospadias, lichen sclerosis, and pelvic radiation. RESULTS During the 39 month study period, 140 men with bulbar urethral strictures met the study criteria: 50 had 0–1 previous endoscopic treatments (group 1), 51 had ≥2 previous endoscopic treatments (group 2), and 39 were excluded due to incomplete records. As shown in the table, repeated endoscopic treatment was strongly associated with longer strictures, more commonly extending into the penile urethra and less often amenable to anastomotic reconstruction. Repeated endoscopic treatment of bulbar urethral strictures was also associated with an 8-fold increase in the symptomatic interval between stricture diagnosis and urethroplasty. Influence of Prior Treatment on Bulbar Urethroplasty Outcome Group 1, n=50 Group2,n=51 p Symptomatic Interval 23months 187 months <0.001 Stricture length 2.29 cm 3.68 cm <0.001 Extension into penile urethra 2(4%) 12(24%) 0.005 Need for flap/graft 6(12%) 21(41%) <0.001 Synchronous strictures 2(4%) 5(10%) 0.436 Recurrence 1(2%) 6(12%) 0.110 CONCLUSIONS Repeated endoscopic treatment of bulbar strictures is associated with increased stricture complexity and a markedly prolonged duration of symptoms. These data suggest that repeated endoscopic intervention is counterproductive and should be discouraged in treatment of bulbar strictures. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e82-e83 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven Hudak Dallas, TX More articles by this author Celeste Valadez Dallas, TX More articles by this author Timothy Atkinson Dallas, TX More articles by this author Allen Morey Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...