MP56-14 AN 18-YEAR ANALYSIS ASSESSING PREDICTORS OF UNSUCCESSFUL GRAFT TAKE AFTER FIRST-STAGE ORAL MUCOSA GRAFT URETHROPLASTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-14 AN 18-YEAR ANALYSIS ASSESSING PREDICTORS OF UNSUCCESSFUL GRAFT TAKE AFTER FIRST-STAGE ORAL MUCOSA GRAFT URETHROPLASTY Ziho Lee, Aaron Stewart, Jolie Shen, Desiree Sanchez, Alexander Skokan, and Judith Hagedorn Ziho LeeZiho Lee More articles by this author , Aaron StewartAaron Stewart More articles by this author , Jolie ShenJolie Shen More articles by this author , Desiree SanchezDesiree Sanchez More articles by this author , Alexander SkokanAlexander Skokan More articles by this author , and Judith HagedornJudith Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Graft take after first-stage oral mucosa graft urethroplasty is an important outcome measure given its implications for technical feasibility and efficacy of multi-stage urethral reconstruction. We review our 18-year experience with first-stage oral mucosa graft urethroplasty, and identify clinical predictors of unsuccessful graft take. METHODS: We retrospectively reviewed all patients who underwent a first-stage oral mucosa graft urethroplasty as part of a planned multi-stage urethral reconstruction from 04/2001-10/2019. In all cases, the oral mucosa graft was fenestrated prior to securing it to the neo-urethral plate with absorbable sutures. The primary outcome measure was unsuccessful graft take, which was assessed between 3 and 12 months postoperatively and defined as an oral mucosa graft plate suboptimal for neo-urethral tubularization. More specifically, patients with unsuccessful graft take included those recommended to undergo repeat first-stage urethroplasty and/or those with <70% graft take. Multivariable logistic regression was utilized to identify clinical predictors of unsuccessful graft take. RESULTS: Of 160 patients who underwent first-stage oral mucosa graft urethroplasty, 32 (20.0%) had unsuccessful graft take. Indications for multi-stage urethroplasty included hypospadias in 55/160 (34.4%) patients, lichen sclerosis in 46/160 (28.8%) patients, trauma in 12/160 (7.5%) patients, and other in 47/160 (29.4%) patients. Within our cohort, 60/160 (37.5%) patients previously underwent at least one failed urethral reconstruction prior to first-stage urethroplasty. Higher body mass index (p=0.020) and positive history of previously failed urethral reconstruction (p=0.011) were independent predictors of unsuccessful graft take. Age at time of surgery (p=0.090), stricture etiology (p=0.691), total area grafted at time of first-stage urethroplasty (p=0.164), history of diabetes (p=0.217), history of cardiovascular disease (p=0.526), and current smoking status (p=0.508) did not predict unsuccessful graft take. CONCLUSIONS: Elevated body mass index and positive history of previously failed urethral reconstruction are associated with unsuccessful graft take after first-stage oral mucosa graft urethroplasty. Patients at risk for unsuccessful graft take after first-stage oral mucosa graft urethroplasty should be appropriately counselled when considering multi-stage urethral reconstruction for complex anterior urethral stricture disease. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e974-e974 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziho Lee More articles by this author Aaron Stewart More articles by this author Jolie Shen More articles by this author Desiree Sanchez More articles by this author Alexander Skokan More articles by this author Judith Hagedorn More articles by this author Expand All Advertisement Loading ...