291 Synchronous Urethral Reconstruction During Urologic Prosthetic Surgery

Abstract

Conventional dogma suggests that management of urethral pathology should not be conducted in the same setting as prosthetic urologic procedures. Recent rare reports of successful urethral repair at the time of device implantation have shown promise. We report our initial favorable experience with synchronous urethroplasty (SU) during urologic implant surgery for patients with urethral injury or other pathology. We retrospectively reviewed patients undergoing inflatable penile prosthesis (IPP) or artificial urinary sphincter (AUS) with SU (2010-2018). Success was defined as absence of complication, urethral stricture and revision surgery. From our database of over 1200 urologic prosthetic patients, we identified seven patients who underwent SU as either (a) “damage control” for intraoperative urethral injury (4/7), or (b) planned repair of urethral abnormality (3/7). Three patients underwent concomitant IPP, four patients had an AUS and one patient had a sling. Urethral injury occurred during urethral dissection (two multiple prior AUS with erosion) or corporal dilation (one recurrent priapism). Planned SU was performed in patients with urethral diverticulum (AUS), urethral stricture (distal bulb repaired with buccal graft and IPP pump revision) and urethroscrotal fistula (pre-existing AUS/IPP with IPP pump revision). Patients were managed postoperatively with suprapubic tube (85.7%, 6/7) or urethral Foley (14.3%, 1/7) for a median of 4 weeks (range 2-6). No patients developed prosthetic infection or urethral stricture during a median follow-up of 38 months (range 4.5-85).