MP3-10 MULTI-CENTER EVALUATION OF ANASTOMOTIC URETHROPLASTY AFTER RADIOTHERAPY FOR PROSTATE CANCER.

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery II1 Apr 2014MP3-10 MULTI-CENTER EVALUATION OF ANASTOMOTIC URETHROPLASTY AFTER RADIOTHERAPY FOR PROSTATE CANCER. Laura Leddy, Jeremy Myers, Joshua Broghammer, Nejd Alsikafi, Bradley Erickson, Sean Elliot, Hunter Wessells, Chris McClung, William Brant, Thomas Smith, and Bryan Voelzke Laura LeddyLaura Leddy More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Sean ElliotSean Elliot More articles by this author , Hunter WessellsHunter Wessells More articles by this author , Chris McClungChris McClung More articles by this author , William BrantWilliam Brant More articles by this author , Thomas SmithThomas Smith More articles by this author , and Bryan VoelzkeBryan Voelzke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.189AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We examined the success of anastomotic urethroplasty after radiotherapy for prostate cancer using data collected from seven urologic reconstruction centers. METHODS An IRB-approved retrospective review was performed of consecutive patients with urethral strictures associated with radiotherapy treatment for prostate cancer at seven reconstructive urology centers between July 2010 - July 2013. We abstracted preoperative patient demographics, operative management and postoperative outcomes. Success was defined as voiding per urethra with cystoscopic urethral patency without the need for endourologic therapy or self-catheterization. RESULTS Twenty-six patients met study criteria. The patient demographics, median operative time, estimated blood loss and estimated stricture length are reported in Table 1. The stricture involved the posterior urethra in 22/26 cases. By our strict definition, 73% of patients achieved success. The median time to failure was 2.4 mo range (range 1.4 – 24.1). Of the six failures one has undergone repeat anastomotic urethroplasty and two have undergone bladder neck incision with a median successful cystoscopic follow up of 20 mo (range 5 – 29). Two require continued suprapubic drainage and the one underwent an ileal conduit. The final patient has an asymptomatic recurrence of <17 Fr. Of the 22 subjects with cystoscopic success (19 initial successes and 3 successes after subsequent procedure), 15/22 had postoperative incontinence. Artificial urinary sphincters have been placed in 9/15 at a median time of 7 months (range 6 – 24) from initial repair. A transcorporal approach was utilized in 4/9 patients. There have been two erosions, one transcorporal and one non-transcorporal, 7.2 and 3.6 months after placement. Clavian classification I or II complications occurred 7/26 patients and were predominantly transient perineal or scrotal pain. All Clavian classification III complications were the result of urethroplasty failure and are discussed above. CONCLUSIONS Anastomotic urethroplasty after radiation therapy is a feasible technique to restore patency of the urethra. Patients should be counseled that adjuvant surgery to treat stress incontinence might be necessary. Success Success Failure Failure Number % Number % DeMOGRAPHICS n 19 7 Median Age (yrs) 66 77 BMI > 30 4 21.1 1 14.3 Diabetes 5 26.3 2 28.6 Prostate Cancer Therapy Prostatectomy 3 15.8 1 14.3 EBRT 14 73.7 4 57.1 Brachytherapy 6 31.6 2 28.6 > one type of XRT 2 10.5 3 42.9 Intraoperative Considerations Operative time (min) 233 278 Estimated blood loss (cc) 317 220 Estimated stricture length (cm) 2.2 3.1 Adjuvant Surgical Maneurvers Transperineal approach 18 94.7 5 71.4 Abdominal & perineal approach 1 5.3 2 28.6 Gracilis muscle flap 6 31.6 2 28.6 Corporal Spllitting 9 47.4 2 28.6 Partial pubectomy 1 5.3 1 14.3 Partial/salvage prostatectomy 5 26.3 0 0.0 Complications Clavian I or II 6 31.6 1 14.3 Clavian III 0 0.0 6 85.7 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e37-e38 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Laura Leddy More articles by this author Jeremy Myers More articles by this author Joshua Broghammer More articles by this author Nejd Alsikafi More articles by this author Bradley Erickson More articles by this author Sean Elliot More articles by this author Hunter Wessells More articles by this author Chris McClung More articles by this author William Brant More articles by this author Thomas Smith More articles by this author Bryan Voelzke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...