90 OUTCOME OF CONTEMPORARY URETHROPLASTY AT A TERTIARY CARE CENTER

Abstract

INTRODUCTION AND OBJECTIVES: To evaluate the stricture free survival rate, adverse events and quality of life (QoL) of urethroplasty in the short term follow-up. METHODS: We retrospectively evaluated our patients who underwent urethroplasty between 12/08 and 07/10 at the University Medical Center Hamburg-Eppendorf, Germany. A standardized nonvalidated questionnaire was sent to all patients in September 2010. Primary end point was the stricture free survival rate, defined as no stricture recurrence. Secondary endpoints were adverse events and QoL. RESULTS: Within 19 months 205 patients underwent urethroplasty due to urethral stricture at different localisations and extend. One hundred forty four patients (70%) with a mean age of 56 years (range 14–84) and a mean follow up of 10.2 months (1–22), responded to our questionnaire. Of this cohort 9%, 85% and 6% were treated by primary excision and re-anastomosis (EPA), buccal mucosa graft (BMG) and mesh graft (MG) urethroplasty, respectively. Overall, 18/144 (12.5%) recurrences were documented and specifically 0%, 14.3% and 12.5 % for EPA, BMG and MG. In Kaplan Meier analysis there was no statistical significant difference concerning the stricture recurrence free survival between the three surgical techniques. Furthermore, no risk factor as localisation, stricture length and number of previous surgeries was identified for early stricture recurrence. Adverse events as incontinence, curvature, shortening and post void wiping out of the urethra were most often associated with MG urethroplasty. However, statistical significant difference was not shown (p 0.05). Neither, there was a statistical significant difference found in QoL nor satisfaction with surgical outcome between the three techniques of urethroplasty (p 0.7). CONCLUSIONS: At our center contemporary urethral surgery signifies a BMG for the majority of patients. Stricture recurrence free survival for EPA, BMG and MG seems comparable. However, EPA demonstrates excellent success rates of urethroplasty in the short term follow up. Differences in adverse events are not statistically significant between EPA, BMG and MG and do not seem to have an impact on quality of life and satisfaction of surgical outcome.