63 SINGLE-STAGE SALVAGE URETHROPLASTY AFTER PREVIOUS OPEN SURGERY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 201063 SINGLE-STAGE SALVAGE URETHROPLASTY AFTER PREVIOUS OPEN SURGERY Kathy Vander Eeckt and Steven Joniau Kathy Vander EecktKathy Vander Eeckt More articles by this author and Steven JoniauSteven Joniau More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.110AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is no common practice in the treatment of urethral strictures after previous open urethral reconstruction in adults. We aimed to assess the results of single-stage salvage urethroplasty after previous open surgery. METHODS 185 patients underwent urethral surgery at our institution between 2003 and 2009. Of those, 35 who had undergone previous open urethral reconstruction (excluding cripple hypospadias) underwent single-stage salvage urethroplasty and were included in the analysis. Different pre- and postoperative parameters were collected: pre- and postoperative maximum flow rate (Qmax), previous urethral manipulations, stricture length, postoperative complications, preoperative remembered IIEF-5 score (r-IIEF-5) and prospectively collected IIEF-5 (p-IIEF-5) score and IPSS at last follow-up. Any urethral instrumentation after surgery was considered a treatment failure. One-way ANOVA, Chi-square and Kaplan-Meier with log-rank test were used for statistical analysis. RESULTS Four patients underwent an end-to-end urethroplasty (12.1%), 6 received a fascio-cutaneous flap reconstruction (18.2%), 19 had a buccal mucosa free graft repair (57.6%) and 4 had an excision of a fistula (12.1%). The mean stricture length was 3.3 cm (SD+/- 2.2). Median preoperative and postoperative maximum flow rate was 8.2 and 18.4 ml/s respectively (p=0.0004). 26.5% of the patients had postoperative complications. (UTI: 2.9%, wound problems: 20.6% and cardiovascular problems: 2.9%). The mean follow-up was 22.3 months (SD+/- 20.5). The 5-year estimated overall failure-free rate was 96.8%. There were no significant differences in outcome comparing different surgical approaches. The median IPSS score at last follow-up was 7 (IQR 2-18). 31.2% of the patients had new onset postmicturation dribbling. There was no significant difference between r-IIEF-5 (mean 19.3 (SD +/-7.4)) and p-IIEF-5 (mean 19.5 (SD +/-8.0)) (p=0.86). CONCLUSIONS The results of salvage single-stage urethroplasty after previous open surgery are very good with a success rate of 96.8%. This high success rate is not at the cost of erectile function decline. Leuven, Belgium© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e26-e27 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathy Vander Eeckt More articles by this author Steven Joniau More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...