History of urethral surgery: Lessons learnt from the past.

Excision and primary anastomosis (EPA) urethroplasty is the standard treatment for traumatic urethral strictures, but managingthem remains challenging for urologists. Identifying factors leading to EPA urethroplasty failure benefits both patients andsurgeons. This study aims to analyze risk factors for urethral stricture recurrence after one-year follow-up of EPA urethroplasty. Data on male patients undergoing EPA urethroplasty at the Urology Department of Saiful AnwarGeneral Hospital from January 2013 until December 2023 were prospectively recorded. Successful urethroplasty, defined as theabsence of additional treatment necessity, was assessed until 12 months follow-up. Demographic data, time to surgery, strictureetiology, comorbidities, prior urethral interventions, and operationsteps were recorded. Univariate and multivariate Cox regression analyses were performed using IBM SPSS Statisticsversion 21. Total 95 patients were observed, and 89 patients wereincluded, averaging 41.2 ± 15.59 years old. EPA urethroplasty succeeded in 91% of cases over a median follow-up of 16.3months. Pelvic fracture urethral injury (PFUI) was the predominant etiology in 74% of cases, with an average stricture lengthof 25.4 ± 16.3 mm. The average time to surgery was performed on average 6.67 ± 4.07 months after diagnosis. In univariateanalysis, body mass index (BMI), time to surgery, and stricture length were associated with urethral stricture recurrence.However, only time to surgery showed a significant association in multivariate analysis. Obesity, the length of the stricture, and delayed surgical intervention are associated with an increased risk of urethral stricture recurrence in patients following EPA. EPA urethroplasty demonstrates a high success rate in managing traumatic urethral strictures.

BACKGROUND: Urinary retention has many etiologies. One of them is urethral stricture or the narrowing of urethral lumen due to fibrotic tissue. Urethral stricture is considered a medical emergency condition because it might cause complications in some extent. At present, there are several surgical techniques introduced with their advantages and disadvantages. AIM: The study aimed to compare the outcome of minimal invasive therapy (MIT) or excision and primary anastomosis (EPA) techniques. METHODS: A retrospective cohort study was performed on patients with partial posterior urethral stricture. The inclusion criteria were all patients with partial posterior urethral stricture who underwent MIT or EPA from 2014 to 2018. The data of International Prostate Symptom Score (IPSS), quality of life (QoL), urinary peak flow rate (Qmax), urine residue, erection hardness score, clean intermittent catheterization (CIC), recurrence, and penile perception scores (PPS) were obtained and analyzed postoperatively. RESULTS: Thirty-four patients included in the study, consisted of 17 patients for each group. EPA group showed significantly superior to MIT in Qmax (p < 0.001), CIC (p = 0.007), and PPS score (p = 0.003). However, no significance differences were found in QoL (p = 0.071), IPSS score (p = 0.083), bladder urine residue (p = 0.688), recurrence (p = 0.225), and erectile function (p = 0.303). CONCLUSION: EPA may be superior to MIT in some aspect. However, other advantages of MIT could be outweighed EPA techniques, such as QoL, IPSS, bladder urine residual, stricture recurrence, and erectile function. MIT still has a place to be the first-line management of partial posterior urethral stricture.

PD63-12 EXCISION AND PRIMARY ANASTOMOSIS RECONSTRUCTION FOR TRAUMATIC STRICTURES OF THE PENILE URETHRA

Background: Urethral strictures cause malfunction of the urethra. Urethroplasty is a cost-effective treatment option. Its success rate is greater than 90% where excision and primary anastomosis(EPA)is performed and 80-85% following substitution urethroplasty. Definitive treatment for recurrent urethral strictures after urethroplasty is not defined. Repeat urethroplasty is a viable option with unknown efficacy.Method: Retrospective analysis of patients who underwent revision urethroplasty for unsuccessful urethroplasty at KNH from 2015 to 2018 was performed. Patients’ age, demographic data, stricture length, location, aetiology, comorbidities and type of urethroplasty was evaluated from records with complete data. Male patients aged 13 to 80years were evaluated. Comparison of urethroplasty outcome between two patient cohorts was made: Fresh urethroplasty patients versus failed urethroplasty who underwent revision so as to determine efficacy of the later. Principal outcome measure was urethral patency, while Subsidiary outcome measures were associated complications. Outcomes were compared using statistical package SPSS version 23.0.Result: 235 patients who met inclusion criteria underwent urethroplasty, 71.5% (n=168) had a successful outcome, while28.5% (n=67) failed and were subjected to revision urethroplasty. Another 58% were successful upon revision but experienced significant morbidity. Majority of urethral strictures were bulbomembranous. Trauma was the leading cause of urethral strictures followed by idiopathic strictures. EPA was the commonest surgery while Tissue transfer featured prominently in revision urethroplasty. A significant correlation was evident between stricture length, prior surgery, and procedure choice and urethroplasty outcome.Conclusion: Revision urethroplasty is feasible after failed urethroplasty but less efficacious. Stricture length, number of prior surgeries and procedure choice affected outcome.EPA and Tissue Transfer techniques are essential surgical armamentarium in revision setting.

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short bulbar or posterior urethral strictures, urethroplasty by excision and primary anastomosis (EPA) is recommended. As EPA only requires the excision of the narrowed segment and the surrounding spongiofibrosis, a full-thickness transection of the corpus spongiosum, as performed in the traditional transecting EPA (tEPA), is usually unnecessary. Jordan et al. introduced the idea of a vessel-sparing approach in 2007, aiming to reduce surgical trauma, especially to the dual arterial blood supply of the urethra, and, thus, potentially reducing the risk of postoperative erectile dysfunction or glans ischemia. This approach could also be beneficial for subsequent urethral interventions such as redo urethroplasty using a free graft, in which a well-vascularized graft bed is imperative. Nevertheless, these potential benefits are only assumptions as prospective studies comparing the functional outcome of both techniques with validated questionnaires are currently lacking. Moreover, vessel-sparing EPA (vsEPA) should at least be able to provide similar surgical outcomes as tEPA. The aim of this paper is to give an elaborate, step-by-step overview of how to manage patients with isolated short bulbar or posterior urethral strictures with vsEPA. The main objective of this manuscript is to outline the surgical technique and to report the representative surgical outcome. A total of 117 patients were managed according to the described protocol. The analysis was performed on the entire patient cohort and on the bulbar (n = 91) and posterior (n = 26) vsEPA group separately. Success rates were 93.4% and 88.5% for the bulbar and posterior vsEPA, respectively. To conclude, vsEPA, as outlined in the protocol, provides excellent success rates with low complication rates for isolated short bulbar and posterior urethral strictures.

1 RECONSTRUCTION OF URETHRAL STRICTURES FOLLOWING PELVIC RADIATION THERAPY: COMPARISON OF RECONSTRUCTION TECHNIQUES

Introduction and Objectives Urethral stricture is a complex pathology of multiple etiologies, and of unknown incidence in our country. There are multiple options for the management of urethral stricture, from minimally invasive procedures, like urethral dilation or direct vision internal urethrotomy, to open surgical reconstruction using excision and primary anastomosis (EPA), or augmented urethroplasty with tissue graft.The aim of the present study is to describe the characteristics of the patients managed with urethral reconstructive surgery in a reference center in eastern Colombia. Methods Observational retrospective cohort study. Data was obtained from patients undergoing urethral reconstructive surgery at the institution from August 2013 to December 2017. All of the surgeries were performed by the same surgical team. The clinical and demographic variables were collected, and the validated urethral stricture surgery patient-reported outcome measure (USS-PROM) questionnaire was applied. Results A total of 56 patients were included in the study, 26 patients (46.4%) underwent excision and primary anastomosis (EPA), and 30 (53.6%) underwent graft urethroplasty. The average age at the time of the intervention was 53.3 years old. The most frequent etiology was trauma, and the mean length of the stenosis was 1.7 cm for the EPA group, and 3 cm for the graft urethroplasty group (p = 0.009). A history of previous surgery was found in 66% of the patients, and radiotherapy in 2 patients.The mean follow-up was of 14 months (range: 0–52 months), observing similar success rates for both techniques. Despite of the small sample size, when analyzing the Kaplan-Meier curves, we observed a tendency of a better response in the group without previous treatments and with stenosis with a length < 2 cm.The rate of postoperative complications was of 23%, with no statistical difference between the 2 groups. The USS-PROM questionnaire was applied to 29 patients, finding that 27 out of 29 respondents were satisfied with the results of the procedure, and all of them would recommend it to another person. Conclusions The results of our study show that urethral reconstruction surgery performed in an experienced center is associated with a good success rate, and that patients are satisfied with the result of the procedure.

PD12-12 EXCISION AND PRIMARY ANASTOMOSIS OR STAGED URETHROPLASTY FOR ANASTOMOTIC STRICTURES AFTER PHALLOPLASTY?

1220 GRAFTS ARE UNNECESSARY FOR PROXIMAL BULBAR RECONSTRUCTION

MP52-01 CORRELATION OF CYSTOSCOPIC URETHRAL STRICTURE STAGE WITH URINARY FLOW AND POSTOPERATIVE IMPROVEMENT

MP78-07 THE PREVALENCE OF CONCOMITANT SQUAMOUS METAPLASIA IN BULBAR URETHRAL STRICTURES AND ITS ASSOCIATION WITH RECONSTRUCTIVE DELAY AND URETHRAL REST BY SUPRAPUBIC URINARY DIVERSION

MP35-19 DECREASED SUCCESS OF GERIATRIC BULBAR URETHROPLASTY

Excision and Primary Anastomosis Reconstruction for Traumatic Strictures of the Pendulous Urethra

Multi-institutional Outcomes and Associations After Excision and Primary Anastomosis for Radiotherapy-associated Bulbomembranous Urethral Stenoses Following Prostate Cancer Treatment

Re: Improving Outcomes of Bulbomembranous Urethroplasty for Radiation-Induced Urethral Strictures in Post-UroLume Era.