PD34-11 MULTI-INSTITUTIONAL OUTCOMES OF ENDOSCOPIC MANAGEMENT OF STRICTURE RECURRENCE AFTER URETHROPLASTY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2017PD34-11 MULTI-INSTITUTIONAL OUTCOMES OF ENDOSCOPIC MANAGEMENT OF STRICTURE RECURRENCE AFTER URETHROPLASTY Shyam Sukumar, Sean Elliott, Jeremy Myers, Bryan Voelzke, Thomas Smith, Alexandra Carolan, Michael Maidaa, and Bradley Erickson Shyam SukumarShyam Sukumar More articles by this author , Sean ElliottSean Elliott More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Thomas SmithThomas Smith More articles by this author , Alexandra CarolanAlexandra Carolan More articles by this author , Michael MaidaaMichael Maidaa More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1534AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Approximately 10-20% of patients will have a recurrence after urethroplasty. Initial management of these recurrences is often with urethral dilation (UD) and direct vision internal urethrotomy (DVIU) but the success rates of these procedures are not well known. METHODS We retrospectively reviewed bulbar urethroplasty data from 5 surgeons from the Trauma and Urologic Reconstruction Network of Surgeons (TURNS). Men who underwent UD or DVIU for a <17F lumen plus symptoms of recurrence were identified. Analyses compared success rates of recurrence management (UD vs. DVIU) and initial urethroplasty type (substitution vs. excisional repair, EPA) using time to event statistics: Kaplan Meier curves and Cox regression models. Failure of UD or DVIU was defined as the inability to pass a 17Fr cystoscope through the urethra into the bladder. RESULTS There were 53 men with recurrence that were initially managed endoscopically, 10 with UD and 43 with DVIU. Mean time to recurrence after urethroplasty was 7.6 months. At a mean follow-up of 16.3 months after UD or DVIU, success was 41.5% in the overall cohort: 48.8% for DVIU vs. 10% for UD. Kaplan Meier curves are shown in Figure 1. On Cox modeling, UD had a higher rate of subsequent failure compared to DVIU (hazard ratio, HR: 3.15, p=0.03). Patients undergoing EPA had a trend towards higher rates of recurrence after secondary endoscopic procedures vs. those undergoing substitution urethroplasty (HR: 2.41, p=0.05) CONCLUSIONS DVIU is more successful than UD in the management of stricture recurrence after bulbar urethroplasty. DVIU appears to be more successful for patients with a recurrence after a substitution urethroplasty compared to after an EPA, perhaps indicating a different mechanism of recurrence for EPA (ischemic) versus substitution urethroplasty (technical) © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e661 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Shyam Sukumar More articles by this author Sean Elliott More articles by this author Jeremy Myers More articles by this author Bryan Voelzke More articles by this author Thomas Smith More articles by this author Alexandra Carolan More articles by this author Michael Maidaa More articles by this author Bradley Erickson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...