MP52-12 RECONSTRUCTION OF LICHEN SCLEROSUS RELATED URETHRAL STRICTURES: OUTCOMES OF LONG PENILE AND PANURETHRAL STRICTURES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2016MP52-12 RECONSTRUCTION OF LICHEN SCLEROSUS RELATED URETHRAL STRICTURES: OUTCOMES OF LONG PENILE AND PANURETHRAL STRICTURES David Chapman and Keith Rourke David ChapmanDavid Chapman More articles by this author and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.488AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lichen sclerosus (LS) related urethral strictures require unique treatment considerations. The two most common surgical dilemmas are how best to reconstruct long penile and panurethral strictures. The purpose of this study is to assess the relative outcomes of reconstruction for both long penile and panurethral strictures caused by LS. METHODS A retrospective review was performed on 975 urethroplasties performed by a single urologist from 2003 to 2014. Sixty-five patients were identified with lichen sclerosus related urethral strictures. Outcomes in long (>2cm) isolated penile strictures and panurethral strictures (>12cm) were examined. Penile strictures were reconstructed with either a staged approach or dorsal onlay using buccal mucosa. Panurethral strictures were treated with either dorsal onlay or urethrostomy augmented with buccal mucosa. The primary outcome measure was urethral patency >16Fr on follow-up cystoscopy and secondary outcomes were 90-day complications, and adverse change in sexual dysfunction or chordee. Outcomes were compared using a two-tailed Fisher’s Exact test. RESULTS Fifty-one patients (mean age 49.6 years) underwent either penile urethroplasty or panurethral reconstruction for LS strictures. Twenty-six patients underwent urethroplasty for penile strictures with a mean stricture length of 5.6cm and overall success of 80.8%. There was no difference between patency rates of staged urethroplasty and one-stage urethroplasty using a dorsal onlay (82.4% vs. 77.8% respectively; p=0.99) with a mean follow-up of 18 months. Complications did not significantly differ between staged and dorsal onlay techniques (p=0.22) nor did adverse change in sexual function/chordee (5.8% vs. 22.2%; p=0.27). The twenty-five patients reconstructed for panurethral strictures had a 48% success rate with a mean follow-up of 49.1 months. Mean stricture length was 14 cm. There was no difference between onlay urethroplasty and augmented urethrostomy with regard to success (40% vs. 53.3%;p=0.69), complications (30% vs. 26.7%;p=0.99) or adverse change in sexual function (p=0.26). Overall, penile strictures fared significantly better than panurethral strictures (80.8% vs. 48% success; p=0.02). CONCLUSIONS Reconstruction of isolated penile urethral strictures related to lichen sclerosus yields satisfactory outcomes with no noted difference between staged and onlay techniques. True panurethral strictures fare worse regardless of which techniques are used. Further advances in this patient group are sorely needed. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e693 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David Chapman More articles by this author Keith Rourke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...