378 RELIABILITY OF A NEW STAGING SYSTEM FOR ANTERIOR URETHRAL STRICTURES

Abstract

INTRODUCTION AND OBJECTIVES: In patients called ‘hypospadias cripples’ because of recurrent urethral strictures, deviation or fistulas after several interventions the functional outcome of reconstructions is seldom reported. The two-staged buccal mucosa urethroplasty remains an option for these patients. We present a large series with long-term functional follow-up. METHODS: Between 2002 and 2011 a two-staged buccal mucosa urethroplasty was performd in 49 patients (age 5-69 years, mean 36, median 27). Most of the patients had initially penile (47%) or penoscrotal (26.5%) hypospadias, two had perineal hypospadias and 6 had additional BXO. They had 1 to 30 previous surgeries (mean 4.6). Most of the patients came for reconstruction because of strictures (89.8%). Additionally we found serious deviation (46.9%), fistulas (14.3%), recurrent urinary tract infections (26%), hair in the urethra (16%) and one urethral stone. For long-term follow-up patients were contacted by questionnaire. 38 (77.5%) answered, mean follow-up is 36 months (4-100 months), median is 46 months. RESULTS: After the first 6 months postoperatively recurrent stenosis was observed in 5 patients (10 %), from whom 3 were treated conservatively, 2 patients got a meatotomy. In the long term follow-up no further complications occurred. According to the questionnaire 63% of the patients void with a good or excellent urinary stream, 95% without any residual urine. 18 (47%) patients suffer of postvoiding dribbling. 11 patients (28.9%) reported problems with the donor side, mainly numbness, only 3 (8%) patients needed reconstruction because of scars. 33 (87%) patients reported no or only slight change of the erectile function. Slight or no deviation postoperatively is seen in 36 (95%) patients, slight or no shortening of the penis in 35 (92%) patients. 26 (68%) patients had no change of ejaculation, the changes which are reported had been mainly less volume or less pressure. Only two patients (5%) had a serious change of their erectile function. 30 (79%) patients were satisfied or very satisfied with the outcome. CONCLUSIONS: The two-staged buccal mucosa urethroplasty is a good option in hypospadias cripples. A good functional outcome can be achieved with no further complications in the long-term follow-up and satisfaction rates of nearly 80%.