MP35-12 AUGMENTED ANASTOMOTIC URETHROPLASTY IN THE TREATMENT OF LONG BULBAR URETHRAL STRICTURES IS INDEPENDENTLY ASSOCIATED WITH STRICTURE RECURRENCE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP35)1 Apr 2020MP35-12 AUGMENTED ANASTOMOTIC URETHROPLASTY IN THE TREATMENT OF LONG BULBAR URETHRAL STRICTURES IS INDEPENDENTLY ASSOCIATED WITH STRICTURE RECURRENCE Elaine Redmond*, Dylan Hoare, Nathan Hoy, and Keith Rourke Elaine Redmond*Elaine Redmond* More articles by this author , Dylan HoareDylan Hoare More articles by this author , Nathan HoyNathan Hoy More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000879.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Controversy exists regarding the optimal urethroplasty technique for bulbar urethral strictures requiring buccal mucosal graft (BMG). Augmented anastomotic urethroplasty (AAU) involves partial stricture excision to remove the most fibrotic portion, with subsequent onlay of the remaining stricture. However, this technique may risk ischemic recurrence through transection of the urethra. “Pure” dorsal onlay (DO) grafting avoids transection of the urethra but may sub-optimally treat obliterative segments at risk of recurrence. The aim of our study was to assess the relative outcomes of AAU versus DO in the setting of bulbar urethroplasty requiring buccal mucosal graft. METHODS: A retrospective review was performed on all patients who underwent urethroplasty with BMG for long (2-10cm) bulbar strictures between October 2003 and March 2019. In ∼2011, institutional technique shifted from routinely performing a transecting augmented anastomotic urethroplasty with dorsal BMG to a non-transecting dorsal onlay. Exclusion criteria included anastomotic urethroplasty without BMG, ventral onlay, staged, flap or circumferential reconstructions. Patients were assessed with routine cystoscopy at 6 months post-operatively and symptomatically thereafter. Recurrence was defined as stricture <16Fr on cystoscopy. Those who failed to attend for cystoscopy were excluded from analysis. Secondary outcomes included 90-day complications. Multivariate Cox regression analysis was performed to assess the impact of technique and other relevant clinical factors on stricture recurrence. RESULTS: Of the 836 patients who underwent bulbar urethroplasty during the study period, 507 met inclusion criteria. Of these, 221 patients received an AAU with dorsal BMG while 286 underwent DO with BMG. Mean patient age and stricture length was 45.4±14.8 years and 4.4±1.5 cm, respectively. Overall success rate was 93.9% with a mean follow-up of 78.9 (5-189) months. On multivariate Cox regression analysis AAU (HR 4.8, 95% CI 1.8-13.3, p=0.002), increasing stricture length (HR 1.2, 95% CI 1.1-1.4, p=0.002) and iatrogenic strictures (HR 3.2, 95% CI 1.1-9.1, p=0.03) were independently associated with stricture recurrence while comorbidity (p=0.06), prior endoscopic treatment (p=0.41), prior urethroplasty (p=0.89) and other etiologies were not. There was no significant difference between the cohorts with respect to 90-day complications (Clavien ≥2) (3.6% vs 4.2%; p=0.74). CONCLUSIONS: AAU is independently associated with stricture recurrence when compared to a pure dorsal onlay technique. This may be related to urethral ischemia. We recommend that AAU should be reserved for longer strictures where DO is precluded due to areas of complete luminal obliteration. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e517-e517 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elaine Redmond* More articles by this author Dylan Hoare More articles by this author Nathan Hoy More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...