MP15-13 ASSOCIATION BETWEEN TYPE OF PERINEAL INCISION AND WOUND COMPLICATIONS AFTER BULBAR URETHROPLASTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) I1 Apr 2015MP15-13 ASSOCIATION BETWEEN TYPE OF PERINEAL INCISION AND WOUND COMPLICATIONS AFTER BULBAR URETHROPLASTY Alexandra Bascom, Sunita Ghosh, Adrian Fairey, and Keith Rourke Alexandra BascomAlexandra Bascom More articles by this author , Sunita GhoshSunita Ghosh More articles by this author , Adrian FaireyAdrian Fairey More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.896AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although wound complications after urethroplasty are uncommon, when they occur it is a significant burden to patients. The objective of this study is to analyze the risk factors for wound specific complications and to determine whether an association exists between the type of incision and wound complications after bulbar urethroplasty. METHODS Retrospective review was performed of 829 urethroplasties performed by a single surgeon from Aug 2004 to June 2014. Patients undergoing an isolated perineal incision were included for analysis. Exclusion criteria included involvement of the penile urethra, including penile and panurethral strictures, incomplete data sets, and strictures secondary to radiation. Wound complications were reported using the modified Clavien-Dindo classification of postoperative complications. Possible risk factors were evaluated using univariable and multivariable analysis; Age, positive preoperative urine culture, Charlson Comorbidity Index ≥ 2, diabetes, body mass index ≥35, smoking, and incision type (Lambda perineal incision (LPI) vs. Midline Perineal Incision (MPI)). RESULTS 540 patients were analyzed, of which 373 patients had a LPI while 167 patients had a MPI. Mean patient age was 43.9 years. Univariable and multivariable analyses indicated that incision type alone was significantly associated with wound complications (Univariable: MPI OR 0.53 (0.34-0.81) p<0.01; Multivariable: MPI OR 0.53 (0.34-0.83) p=0.01). Ninety-day wound complications (any Clavien grade) occurred in 24.9% (93 patients) of LPIs compared to 11.9% (20 patients) of MPIs (p=0.0006). The majority of complications were Clavien ≤2, which occurred in 23.3% (87 patients) of LPIs compared to 11.9% (20 patients) of MPIs (p=0.0023). There was no significant difference in the rate of Clavien ≥3 complications. The only wound complication that differed significantly between the LPI and the MPI was superficial wound edge separation (LPI 10.7% (40 patients); MPI 0%, p<0.0001). There was no identified difference in urethroplasty outcome (6-month stricture recurrence: LPI 6.3% vs. MPI 0%). CONCLUSIONS A lambda perineal incision is independently associated with increased 90-day wound complications after urethroplasty, and is associated with more superficial wound edge separation compared to the midline incision. The lambda incision offered no identifiable advantage in urethroplasty outcome. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e164 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Bascom More articles by this author Sunita Ghosh More articles by this author Adrian Fairey More articles by this author Keith Rourke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...