PD16-04 FACTORS AFFECTING FEASIBILITY OF SAME DAY ANTERIOR URETHROPLASTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2016PD16-04 FACTORS AFFECTING FEASIBILITY OF SAME DAY ANTERIOR URETHROPLASTY Jeremy Reese, Katherine Theisen, Vladimir Lamm, and Mang Chen Jeremy ReeseJeremy Reese More articles by this author , Katherine TheisenKatherine Theisen More articles by this author , Vladimir LammVladimir Lamm More articles by this author , and Mang ChenMang Chen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1156AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Anterior urethroplasty has historically been managed with a 1-3 day postoperative hospitalization. More recent literature has demonstrated the safety of same-day anastomotic and ventral onlay buccal urethroplasties. Despite these publications, reports on national trends suggest a pattern of continued admissions with an average length of stay on 2.5 days. At our tertiary care center, we routinely discharge patients on the same day following substitution and anastomotic urethroplasy. We sought to assess factors affecting feasibility of outpatient urethroplasty. METHODS We performed a retrospective chart review of 91 consecutive anterior urethroplasty patients (11 anastomotic, 80 substitution) performed by a single surgeon from August 2012 through May 2015. We compared parameters of stricture length, length of stay, stricture etiology, number and type of prior stricture surgeries and stricture recurrence rates between our admitted and same day surgery groups. RESULTS Seventy-five of 91 (82%) patients were discharged home the day of surgery. The average length of stay for admitted patients was 1.48 days (range 0.7-2.8 days). Eight of 17 admissions (47%) were planned for either patient preference or known medical comorbidities (ex: mental illness, COPD, CKD). Of the 9 unplanned admissions, 5 were for pain control and/or patient anxiety, 2 for difficulties with anesthesia, and 2 for extended operative times (trauma patient requiring pubectomy, scar excision and primary anastomosis; obese patient with 18cm urethral stricture). There were no significant differences between the admission group compared to the same day group in recurrence rate (11.8% vs 10.3%, p>0.05), stricture length (5.1cm vs 4.6cm, p>0.05), age (47 vs 47 years old), number of prior stricture surgeries (1.7 vs 2.5, p>0.05), type of prior procedures, or etiology of stricture disease, respectively. 93% of the same day patients had a prior surgery compared to 88% in the admission group (p>0.05). While etiology of stricture disease was unknown in many cases, trauma was suspected in 32% of the same day group compared with 38% in the admission group (p>0.05). CONCLUSIONS We describe the largest single surgeon series of outpatient anterior urethroplasty to date including more complex single stage panurethral substitution repairs than previously reported. No single stricture characteristic seems to determine the likelihood of outpatient surgery; rather patient preference and non-urologic comorbidities predict the feasibility of performing same day anterior urethroplasty. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e395 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Jeremy Reese More articles by this author Katherine Theisen More articles by this author Vladimir Lamm More articles by this author Mang Chen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...