MP22-07 OUTCOMES OF DORSAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN PATIENTS WITH POST-PROSTATECTOMY, POST-RADIATION ANASTOMOTIC CONTRACTURE

Abstract

You have accessJournal of UrologyCME1 May 2022MP22-07 OUTCOMES OF DORSAL ONLAY BUCCAL MUCOSAL GRAFT URETHROPLASTY IN PATIENTS WITH POST-PROSTATECTOMY, POST-RADIATION ANASTOMOTIC CONTRACTURE Joshua Sterling, Alex Wang, Kelly Crane, Javier C. Angulo, Wagner Franca, Brian Flynn, Francisco Martins, Erick A. Ramirez, Paul Rusilko, Jay Simhan, Daniel Swerdloff, and Dmitriy Nikolavsky Joshua SterlingJoshua Sterling More articles by this author , Alex WangAlex Wang More articles by this author , Kelly CraneKelly Crane More articles by this author , Javier C. AnguloJavier C. Angulo More articles by this author , Wagner FrancaWagner Franca More articles by this author , Brian FlynnBrian Flynn More articles by this author , Francisco MartinsFrancisco Martins More articles by this author , Erick A. RamirezErick A. Ramirez More articles by this author , Paul RusilkoPaul Rusilko More articles by this author , Jay SimhanJay Simhan More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , and Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment of patients with vesicourethral anastomotic contracture (VUAS) /membranous stenosis (Sp) following a combination of prostatectomy and radiation treatment for prostate cancer (CaP) are understudied. We evaluate feasibility of dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) and evaluate patency and continence outcomes in patients with a history of prior radical prostatectomy and radiation therapy. METHODS: Retrospective multi-institutional review of patients with post-prostatectomy, post-radiation VUAS/Sp from 8 institutions between 2013-2021 was performed. Patients with at least 8-months follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were recurrence and development of de-novo stress urinary incontinence (SUI). Secondary outcomes were surgical complications, changes in voiding and patient-reported satisfaction using a Global Response Assessment (GRA). RESULTS: Of 48 patients treated with D-BMGU for stenosis following prostatectomy and radiation, 38 met the inclusion criteria. Median age and stenosis length were 68.5 years, (IQR 63.25-72), and 2.75 cm (IQR 2-4 cm), respectively. Prior CaP treatment modalities included primary robotic prostatectomy and subsequent salvage or adjuvant radiotherapy in 89% (34/38) and primary radiation and salvage prostatectomy in 11% (4/38). The mean length of stay after D-BMGU was 1.5 days (IQR 1-2). At a median follow-up of 21 months (IQR 13-39), 5 patients (13%) had recurrence. Among 11 preoperatively-continent patients (31%) all retained continence. Of 20 patients with preoperative SUI (52%), all but one (95%) remained incontinent post-operatively. Continence was unknown for 7 patients and 3 had post operative incontinence. 47% (17/36) of the cohort subsequently received an artificial urinary sphincter. Patients experienced significant improvement in PVR (158 to 47 cc, p <0.001) and Uroflow (6.3 to 15.4 cc/s, p <0.001), and also reported high overall satisfaction, with 84% reporting a GRA of +2 or better. CONCLUSIONS: Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation post prostatectomy anastomotic contracture. Although our findings suggest the DBMGU technique may confer lower rates of de-novo SUI compared to conventional urethral transection, head-to-head comparisons are needed to further characterize any continence benefit. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e374 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Sterling More articles by this author Alex Wang More articles by this author Kelly Crane More articles by this author Javier C. Angulo More articles by this author Wagner Franca More articles by this author Brian Flynn More articles by this author Francisco Martins More articles by this author Erick A. Ramirez More articles by this author Paul Rusilko More articles by this author Jay Simhan More articles by this author Daniel Swerdloff More articles by this author Dmitriy Nikolavsky More articles by this author Expand All Advertisement PDF DownloadLoading ...