Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence

James R Furr,Joel Gelman,Eric S Wisenbaugh

doi:10.1007/s00345-021-03676-8

James R Furr, Joel Gelman + Show 1 more

Open Access

https://doi.org/10.1007/s00345-021-03676-8

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Abstract

PurposeTo report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence.Methods We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success.Results Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3–17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6–240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months.ConclusionStaged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.

Highlights

Staged urethroplasties are becoming less frequent as many long, complex urethral strictures are being repaired in a single stage [1]
Consequence, staged repairs are still commonly performed for strictures as a result of failed prior hypospadias surgery, highly complex strictures that have been treated with prior open reconstruction, and select complex cases of lichen sclerosus (LS) known as Balanitis Xerotica Obliterans (BXO)
We aim to present an analysis of our series of staged urethroplasties using buccal mucosa grafts (BMG) and/or STGT harvested from the thigh to include early assessment of anatomic success and long-term follow-up with patient reported outcome measures (PROMs)

Summary

Introduction

Staged urethroplasties are becoming less frequent as many long, complex urethral strictures are being repaired in a single stage [1]. It is clearly established that genital skin is not recommended for the treatment of urethral strictures associated with LS when used as flap or grafts [2]. Despite early success, this change in clinical practice away from the use of genital skin occured because of the very high late failure rate that was observed when there was long-term follow-up of up to 10 years [3, 4]. The fact that substitution urethroplasty including staged repairs can in certain cases, be associated with a high late failure rate indicates the importance of longterm outcome assessment

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