PD14-04 REPEAT ENDOSCOPIC MANIPULATION FOR BULBAR URETHRAL STRICTURES INCREASES STRICTURE LENGTH AND URETHROPLASTY COMPLEXITY BUT DOES NOT AFFECT URETHROPLASTY OUTCOMES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Urethral Reconstruction (including Stricture) II1 Apr 2015PD14-04 REPEAT ENDOSCOPIC MANIPULATION FOR BULBAR URETHRAL STRICTURES INCREASES STRICTURE LENGTH AND URETHROPLASTY COMPLEXITY BUT DOES NOT AFFECT URETHROPLASTY OUTCOMES David W. Chapman, Abhaya Prasad, Adam Kinnaird, and Keith Rourke David W. ChapmanDavid W. Chapman More articles by this author , Abhaya PrasadAbhaya Prasad More articles by this author , Adam KinnairdAdam Kinnaird More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1333AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Endoscopic procedures, in the form of dilation or direct vision urethrotomy remain the most commonly used treatments for urethral stricture. Repeat endoscopic procedures, however, do not typically offer cure and may increase stricture complexity, threatening urethroplasty outcomes. Our objective was to evaluate the association between the number of endoscopic procedures with stricture length, urethroplasty complexity and urethroplasty outcomes. METHODS A retrospective review of 840 consecutive urethral reconstructions performed by a single surgeon between August 2003 and May 2014 was completed. Exclusion criteria were prior urethroplasty, penile or panurethral strictures, posterior stenosis, staged repair or incomplete datasets. Number of endoscopic treatments were analysed as an ordinal variable by dividing the number of endoscopic treatments into 4 groups (group 1 = 0 treatments, group 2= 1-2, group 3 = 3-5, group 4 = greater than 5) and as a continuous variable. Preoperative patient demographics and postoperative outcomes were first compared using univariate binary regression, followed by multivariate binary regression. Outcomes measures were stricture length (measured intra-operatively), complexity of urethroplasty (either an anastomotic technique or a more complex tissue substitution), urethroplasty success (defined as the easy passage of a 16Fr cystoscope), and Clavien complications. RESULTS Of the 430 patients with bulbar urethral strictures eligible for analysis, 49 were in group 1, 182 were group 2, 141 in group 3, and 58 were group 4. Using linear regression as both an ordinal and continuous variable, an increase in the number of endoscopic manipulations was strongly associated with increased stricture length (p<0.001 and p=0.01) and urethroplasty complexity (p<0.001 and p=0.02). Using multivariate binary regression, no association of urethroplasty success or complications were found with number of endoscopic treatments (p=0.85 and p=0.56, respectively). Urethroplasty failed in 2% of group 0 (1/50), 6.6% of group 1 (12/182), 9.0% of group 3 (13/143), and 8.6% of group 4 (5/65). CONCLUSIONS Temporizing patients with repeat endoscopic procedures is associated with increasing stricture length and urethroplasty complexity. Despite this, no association was found between the rate of stricture recurrence or accompanying urethroplasty complications. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e320 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information David W. Chapman More articles by this author Abhaya Prasad More articles by this author Adam Kinnaird More articles by this author Keith Rourke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...