MP03-11 THE EFFECT OF POSTOPERATIVE TADALAFIL IN REDO-URETHROPLASTY FOR PATIENTS WITH PELVIC FRACTURE URETHRAL INJURY: A NON-RANDOMIZED TWO ARMS TRIAL

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP03)1 Sep 2021MP03-11 THE EFFECT OF POSTOPERATIVE TADALAFIL IN REDO-URETHROPLASTY FOR PATIENTS WITH PELVIC FRACTURE URETHRAL INJURY: A NON-RANDOMIZED TWO ARMS TRIAL Pankaj M. Joshi, Marco Bandini, Amey Patil, Shreyas Bhadranavar, Yatam L. Shreeranga, Vipin Sharma, Guido Barbagli, Francesco Montorsi, and Sanjay B. Kulkarni Pankaj M. JoshiPankaj M. Joshi More articles by this author , Marco BandiniMarco Bandini More articles by this author , Amey PatilAmey Patil More articles by this author , Shreyas BhadranavarShreyas Bhadranavar More articles by this author , Yatam L. ShreerangaYatam L. Shreeranga More articles by this author , Vipin SharmaVipin Sharma More articles by this author , Guido BarbagliGuido Barbagli More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Sanjay B. KulkarniSanjay B. Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001964.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pelvic fracture urethral injury (PFUI) is common in developing countries, invariably as a result of road traffic trauma. Repair is complex and redo cases are even more challenging with decreasing chances of success. The reasons behind the low success rate are the compromised the blood supply, and the fibrotic process which respectively decrease and increase at any attempted surgery. We believe that blood supply can be pharmacologically improved after redo-surgery, with the use of phosphodiesterase (PDE) inhibitors. Similarly, we also believe that PDE inhibitors may decrease the amount of post-operative fibrosis. We aimed to test the effect of tadalafil on success rate after redo-urethroplasty in patients referred for PFUI. METHODS: This was a prospective (2017-2019) non-randomized and non-placebo-controlled trial (KESI02012017). Men with PFUI receiving redo-urethroplasty were allocated to two non-randomized groups. Group 1 received tadalafil 5mg from the first postoperative day for 90 days after surgery. Group 2 did not receive tadalafil. Inclusion criteria were patients undergoing redo-urethroplasty willing to enter the trial and accepting to take low dose of tadalafil postoperatively. Exclusion criteria were <18 years, females, primary cases and complex cases such as those with recto-urethral fistula. Failure was defined as redo urethroplasty or any need for instrumentation (i.e. DVIU or dilatation) after surgery. RESULTS: Overall, 60 patients were enrolled (29 Group 1 vs 31 Group 2) in our study. No statistically significant differences emerged between groups in terms of age (32 vs 30 yrs), diabetes (10 vs 6.4%), length of gap (2.9 vs 2.8 cm), and previous attempted surgery (1.3 vs 1.1), all p>0.05. The majority of patients in both groups required Step 3 (pubic bone osteotomy) anastomotic urethroplasty (72 vs 65%). Median follow up was 19.5 months (5-39 months). Overall success rate was 83.3% (50 patients). Only 1 patient in the tadalafil group failed, compared to 9 in the non-tadalafil group. The success with tadalafil was 96.6%, compared to 71.0% in the non-Tadalafil group (p 0.0008). CONCLUSIONS: In our non-randomized and non-placebo-controlled trial, we found an improved success rate, after redo-urethroplasty for PFUI, in those patients receiving 5 mg of tadalafil for 3 months after surgery compared to those who did not receive tadalafil. Future randomized double-blinded placebo-controlled trials are awaited to evaluate the use of postoperative tadalafil 5mg in patients undergoing redo-urethroplasty for PFUI. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e25-e25 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj M. Joshi More articles by this author Marco Bandini More articles by this author Amey Patil More articles by this author Shreyas Bhadranavar More articles by this author Yatam L. Shreeranga More articles by this author Vipin Sharma More articles by this author Guido Barbagli More articles by this author Francesco Montorsi More articles by this author Sanjay B. Kulkarni More articles by this author Expand All Advertisement Loading ...