Abstract
Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who underwent ventral onlay oral graft urethroplasty for bulbar strictures. Exclusion criteria were traumatic strictures, lichen sclerosus, failed hypospadias repair, failed urethroplasty, panurethral strictures, and incomplete medical charts. Pre-operative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, ultrasound and urethroscopy. Surgery was considered a failure when any post-operative instrumentation was needed. Median follow-up was 48 months. Out of 184 patients, 38 (20.7%) had not undergone previous treatment, 7 (3.8%) had undergone dilation, 81 (44%) DVIU and 58 (31.5%) DVIU associated with dilation. Out of 184 patients, 157 (85.3%) were successful and 27 (14.7%) failures. Out of 38 patients who had not undergone previous treatment, 33 (86.8%) were successful; out of 7 patients who had undergone dilation, 6 (85.7%) were successful; out of 81 patients who had undergone DVIU, 72 (88.9%) were successful; out of 58 patients who had undergone DVIU and dilation, 46 (79.3%) were successful. According to the number of previous DVIU, ventral graft urethroplasty for bulbar strictures showed high failure rate in patients who had undergone more than four DVIU associated or not with dilation.
Highlights
Reconstructive urethral surgery has greatly improved in both safety and effectiveness in the last 10 years and urethral stricture should be considered an open surgical disease [1]
Wright et al suggested that the most cost-effective strategy for the management of short bulbar urethral strictures is to reserve urethroplasty for patients in whom a single direct visual internal urethrotomy (DVIU) has failed [13]
Rourke and Jordan suggested that treatment for short bulbar urethral strictures with primary reconstruction is less costly than treatment with DVIU [14]
Summary
Reconstructive urethral surgery has greatly improved in both safety and effectiveness in the last 10 years and urethral stricture should be considered an open surgical disease [1]. Several authors analyzed the trends in male urethral stricture management in the United States using the data from the 1992-2001 Medicare claims [8] These authors concluded that despite the poor overall efficacy of dilation and DVIU, urethroplasty rates were the lowest of all. In 1996, 1997, 1998, three articles in the literature, including one on a large series of patients, showed that repeated dilation or DVIU are not clinically effective [9,10,11]. For many years, these three articles were considered and quoted in the literature as fundamental milestones on this topic. We retrospectively reviewed a large and homogeneous series of patients who underwent ventral onlay graft urethroplasty for bulbar urethral strictures to investigate if previous failed dilation or DVIU were predictive of urethroplasty failure
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
