Abstract
PurposeRedo-urethroplasty is a challenge for any genitourethral surgeon, with a number of techniques previously described. This systematic review aims to identify the surgical techniques described in the literature and evaluate the evidence for their effectiveness in managing recurrent urethral strictures.Materials and methodsA systematic review of the MEDLINE and EMBASE databases from 1945 to July 2018 was performed and the urethroplasty procedures were classified according to the site and surgical technique. Primary outcomes included success rates measured via re-stricture rates and the post-op maximum urinary flow rate. Secondary outcomes included complication rates and patient-reported quality of life.ResultsA total of 39 identified studies met the inclusion criteria. Twenty-two studies described the use of excision and primary anastomotic urethroplasty with success rates showing wide variability (58–100%). Success rates reported according to the site of the stricture also varied: bulbar (58–100%) and posterior (69–100%) recurrent strictures. One-stage substitution urethroplasty was described in 25 studies with success rates of 18–100%, with the best outcomes reported for bulbar (58–100%) and hypospadias-related (78.6–82%) strictures. Two-stage substitution urethroplasty was described in 12 studies with the success rates of 20–100%, with the best evidence related to hypospadias-related and posterior urethral strictures. The buccal mucosa graft was the graft source with the best evidence for substitution urethroplasty (18–100%).ConclusionsTrends of effectiveness were identified for redo-urethroplasty modalities in different locations. However, the current levels of evidence are limited to small observational studies, highlighting the need for further larger prospective data to evaluate different techniques used for recurrent urethral strictures.
Highlights
Open reconstructive urethroplasty offers a cost-effective treatment modality for urethral strictures with excellent early success rates of 79–95% [1]
We present the second systematic review on the outcomes of redo-urethroplasty, with a previous review of five studies, including paediatric cases conducted [51]
The success rates of redo surgery after failed urethroplasty are comparable to primary surgery when the appropriate technique is used
Summary
Open reconstructive urethroplasty offers a cost-effective treatment modality for urethral strictures with excellent early success rates of 79–95% [1]. Long-term results demonstrate that 14–42% of patients require additional treatment for recurrent strictures after primary surgical reconstruction [2]. There are few standardised guidelines for the treatment of urethral stricture recurrence following urethroplasty, with practice varying widely between urologists [3]. Redo-urethroplasty and direct vision internal urethrotomy (DVIU) are the established techniques. DVIU remains the most commonly utilised initial method, as it offers a minimally invasive approach with fewer technical challenges, and allows endoscopic assessment of the recurrent stricture. Whilst identified as a valuable therapeutic option for short
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