33 POSTOPERATIVE IMAGING IS UNNCESSARY AFTER ANASTOMOTIC URETHROPLASTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 201033 POSTOPERATIVE IMAGING IS UNNCESSARY AFTER ANASTOMOTIC URETHROPLASTY Ryan Terlecki, Matthew Steele, Celeste Valadez, Bruce Schlomer, and Allen Morey Ryan TerleckiRyan Terlecki More articles by this author , Matthew SteeleMatthew Steele More articles by this author , Celeste ValadezCeleste Valadez More articles by this author , Bruce SchlomerBruce Schlomer More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.078AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Following urethroplasty, contrast studies are commonly performed to assess healing of the anastomosis and to determine suitability of urethral catheter removal: we have observed that most of these studies appear to be time-consuming, bothersome, and unhelpful. We evaluated our experience with imaging after various methods of urethral reconstruction to determine the necessity and clinical impact of post-urethroplasty imaging. METHODS We reviewed our database of all urethroplasties performed by a single reconstructive urologist at our referral center during a two year period. Patients underwent postoperative voiding cystourethrography (VCUG) at a mean of 24 days after surgery. Data analyzed included patient history and demographics, operative details, imaging results, and clinical outcomes. Results of imaging were stratified according to specific types of procedures performed. RESULTS From 2007-2009, 210 patients underwent urethral reconstruction at our center. Patients undergoing meatoplasty or staged repairs were excluded, leaving 156 patients with postoperative imaging for analysis. Of the 110 anterior urethroplasties, 59 (54%) consisted of excision and primary anastomosis (EPA) via a two-layer technique, 28 (25%) had an augmented anastomotic (AA) procedure, and 23 (21%) were pure ventral onlays (flap or graft). All 46 posterior urethroplasties (PU) were performed with scar excision and primary anastomosis. Of the 156 patients, only 4 (2.6%) had extravasation on postoperative VCUG (2 PU, 1 AA, 1 ventral onlay)–these were managed with catheter replacement and subsequent removal at a mean of 8 days afterward. None of the 59 men having EPA procedures demonstrated extravasation on VCUG. CONCLUSIONS Routine post-operative imaging after urethral reconstruction appears to have little impact on patient care in the vast majority of cases. Extravasation on post-urethroplasty VCUG is rare when performed after approximately three weeks of healing. Imaging can be omitted following uncomplicated EPA urethroplasty. Dallas, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e14 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Terlecki More articles by this author Matthew Steele More articles by this author Celeste Valadez More articles by this author Bruce Schlomer More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...