Outcome Predictors of Augmentation Urethroplasty Using Dorsal Onlay Buccal Mucosal Graft

Abstract

Background: The incidence and timing of stricture recurrence and factors affecting urethroplasty outcomes remains incompletely characterized. Objective: To evaluate and determine the factors predicting the outcome of dorsal onlay buccal mucosal graft (BMG) urethroplasty. Patients and Methods: We analyzed the records of 115 patients underwent dorsal onlay BMG urethroplasty at Al-Azhar University Hospitals in Cairo, Egypt, from January 2015 to April 2018, with a minimum of 12 months of followup. The risk factors examined were patient age, stricture etiology, site, length, width, diabetes, hypertension, smoking, obesity, previous visual internal urethrotomy (VIU) and urethroplasty, early postoperative complications, extravasation at first periurethral ascending cystourethrogram (ACUG) and stricture width. Results: Average patients age was 38 years. Stricture free rate was 90.4% and mean followup period was 47.5 months (range 12 to 67). Average stricture length was 5.9 cm, average stricture width was 6.3 mm, 63.4% of patients were with previous VIU, and 9.5% were with previous urethroplasty. On univariate analysis, etiology, site of stricture, previous four or more times VIU, DM, obesity, stricture length, postoperative (post op.). wound infection and leakage at first periurethral ACUG were associated with stricture recurrence. On multivariate analysis panurethral stricture (HR 280.6, 95% CI 9.1-8622.8, p =0.001), traumatic stricture (HR 17.1, 95% CI 2.4-123.4, p =0.005) were independent predictors of stricture recurrence. Stricture width, previous urethroplasty, the number of failed endoscopic procedures less than 4 times, smoking, HTN and patient age did not affect the recurrent stricture rate. Conclusion: panurethral and traumatic strictures were independent predictors of stricture recurrence.