PD63-11 CHANGING TRENDS IN RECONSTRUCTION OF COMPLEX URETHRAL STRICTURES: FROM SKIN FLAP TO PERINEAL URETHROSTOMY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III1 Apr 2018PD63-11 CHANGING TRENDS IN RECONSTRUCTION OF COMPLEX URETHRAL STRICTURES: FROM SKIN FLAP TO PERINEAL URETHROSTOMY Joceline Fuchs, Nabeel Shakir, Maxim McKibben, Jeremy Scott, Boyd Viers, Travis Pagliara, and Allen Morey Joceline FuchsJoceline Fuchs More articles by this author , Nabeel ShakirNabeel Shakir More articles by this author , Maxim McKibbenMaxim McKibben More articles by this author , Jeremy ScottJeremy Scott More articles by this author , Boyd ViersBoyd Viers More articles by this author , Travis PagliaraTravis Pagliara More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2971AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although tissue transfer operations such as buccal mucosal graft (BMG) and penile skin flaps are commonly used for complex urethroplasty cases, outcomes for reconstruction of severe strictures can be unreliable. We report our evolving approach to reconstruction of complex strictures over the last decade. METHODS We retrospectively reviewed a large series of complex urethral reconstruction cases comparing three techniques: a) BMG, b) penile skin flap or c) perineal urethrostomy (PU) at a tertiary center (2007-2017) with ≥ 6 months follow-up. Strictures amenable to anastomotic repair were excluded. Success was defined as no need for further operative management. RESULTS Among 1129 stricture cases, 406 complex strictures were identified for this analysis (median length 4.6 cm). Reconstruction was most commonly performed using BMG urethroplasty (242/406, 59.6‰), followed by penile skin flap (85/406, 20.9‰) and PU (79/406, 19.5‰). PU use has increased steadily and significantly over the past decade, rising from 4.3‰ of case volume in 2008 to 38.7‰ of urethral reconstruction cases in 2017 (p=0.01). Over time, the proportion of complex reconstruction using BMG has remained stable, while penile skin flaps are now less commonly utilized (Figure). Over a median follow-up of 52.0 months, 18.7‰ (76/406) patients failed at a median of 13.9 months. Success rates were higher following PU (92.7‰) compared to BMG and skin flaps (76.0‰ and 78.3‰, respectively) (p<0.01) despite PU patients being older (mean age 61.4 yr), having longer strictures (5.6 cm) and more commonly having LS (20.2‰). LS patients are increasingly managed with PU in our practice, with PU performed in 58.3‰ (14/24) of complex LS cases over the last 3 years, with the exception of young men who are more likely to choose attempted repair using BMG (median age BMG 46.5 yr vs. PU 60.4 yr). CONCLUSIONS Over a decade of a urethral reconstructive practice, PU is increasingly utilized for older patients with long strictures and adverse etiology. BMG urethroplasty rates remain stable, while penile skin flap use is decreasing. Success rates of PU for these complex strictures are markedly higher than those of grafts and flaps. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1218 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Joceline Fuchs More articles by this author Nabeel Shakir More articles by this author Maxim McKibben More articles by this author Jeremy Scott More articles by this author Boyd Viers More articles by this author Travis Pagliara More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...