Success Rate Of Urethroplasty Research Articles

Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference?

PurposeWe aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome.Materials and methodsWe retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients’ demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more.ResultsThe urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively.ConclusionsUnfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.

Analysis in the influence factors of urethroplasty in DSD

BackgroundAt present, there is no specific research on the factors affecting the success rate of urethroplasty in patients with DSD. The purpose of this study is to explore the factors affecting the success of urethroplasty in DSD patients, and to provide some reference for the surgical treatment of DSD patients undergoing urethroplasty.MethodWe reviewed patients with DSD who underwent urethroplasty from January 2016 to December 2019 retrospectively. Patients were divided into four groups: the successful group, the urethrocutaneous fistula group, the urethral diverticulum group, and the urethral stricture group. Risk factors were determined from the following data included the DSD classification, the age of first operation, length of urethral defect, degree of hypospadias, cryptorchidism, micropenis, gonad type, hormone therapy before operation, transposition of penis and scrotum, surgical strategy, urethral covering material, and postoperative catheter removal time. We explored the difference of each factor between four groups through the comparative study of single factor and multifactor logistic regression analysis of related factors.Result122 cases were enrolled in this group (n = 122), 12 cases were lost to follow-up. Median follow-up was 28 months (12–55 months).We found the success rate of operation decreased with longer urethral defect (B = − 0.473, P = 0.005). The success rate of operation was higher in staged operation and TPIT (TPIT = Transverse Preputial Island Tube operation)-related operation than primary operation (B = 1.238, P = 0.006) and TPIT-nonrelated operation (B = 2.293, P = 0.001). Although there was a significant difference between the age of the first operation and the occurrence of urethrocutaneous fistula (P = 0.006 < 0.05), there was no significant difference in logistic regression analysis (P = 0.161 > 0.05). The incidence of urethrocutaneous fistula was lower in TPIT-related operation than in TPIT-nonrelated operation (B = − 2.507, P = 0.000). The incidence of postoperative urethral diverticulum was lower in staged operation than in primary operation (B = − 1.737, P = 0.015).ConclusionFor patients with disorder of sex development undergoing urethroplasty, the length of urethral defect is an independent risk factor affecting both the success rate of operation and the urethrocutaneous fistula. The age of the first operation has a statistically significant effect on the occurrence of postoperative urethrocutaneous fistula, but it is not an independent factor. Urethrocutaneous fistula is less found in TPIT-related operation in the study. Staged operation is an independent protective factor for postoperative urethral diverticulum compared with one-stage operation but isn’t related to urethrocutaneous fistula.

Urethroplasties for male urethral strictures: Success rates and predictive factors

Urethroplasty has reported success rates ranging from 60 to 98%. Predictive factors for recurrence are rarely studied, postoperative urinary drainage modalities are not investigated. The primary objective was to evaluate the success rate of urethroplasty in our center. Secondary objectives were to identify recurrence predictive factors. A single-center retrospective cohort including men treated with urethroplasty for stricture between 2007-2017, followed up for a minimum of 12 months. Recurrence was defined as the necessity of a new procedure (endo-urethral or surgical). Data from penile urethra (SUP) and bulbo-membranous urethra (SUBM) stenosis were analyzed separately. Recurrence-free survival (success) was analyzed according to the Kaplan-Meier model. The characteristics of the patients, the stenosis, the surgical technique, the modalities of postoperative urinary drainage were analyzed in subgroups for the bulbo-membranous urethra looking for a correlation with recurrence. A total of 103 patients included: 25 with SUP, 78 with SUBM. The overall success rate was 69%, CI95% [60-79] with a mean follow-up of 62.85 months. The success was 68%, CI95%[46-82] for SUP, 69.23%, CI95% [58-78] for SUBM. Recurrences occurred during the first 12 months. Only postoperative suprapubic urinary drainage was a predictive factor (HR=0.947, CI95% [0.905-0.992]). A period longer than 14 days reduced recurrence by 37%. Urethroplasty had a success rate of 69%, comparable to published series. Suprapubic urinary drainage improved the surgery outcomes. 2, Grade B.

EDITORIAL COMMENT

This is a welcome report by an experienced group, reporting necessarily small numbers . Here, the addition of buccal graft appears to increase the historical urethroplasty success rate by as much as 30% for both 1 and 2 stage techniques. One-stage double buccal urethroplasty had a 20% failure rate (n = 9) and two-stage Johanson-type urethroplasty (with buccal graft placed in the first stage) had a 0% failure rate (n = 5) although they were subjectively higher-risk patients (poor tissue vascularity or previous failed urethroplasty).

Lingual mucosa graft ureteroplasty for ureteral stricture: a narrative review of the current literature

Long proximal or middle ureteral strictures remain challenging conditions. Although ileal replacement of the ureter or renal autotransplantation are possible solutions for these problems, both present complexities and considerable morbidity. In recent years, many urologists have tended to use oral mucosal grafts to repair complex proximal or middle ureteral strictures and thereby avoid ileal replacement and renal autotransplantation. A comprehensive search of oral mucosa graft ureteroplasty and lingual mucosa graft (LMG) ureteroplasty was performed. All literatures must be in English language. Most reports related to oral mucosa graft ureteroplasty focus on buccal mucosa grafts (BMGs). The available data about LMG ureteroplasty are limited. Both LMG and BMG are oral mucosa grafts that have similar histological structures. The success rates of urethroplasty with LMG and BMG are similar. Although there is still no comparative study between LMG and BMG for ureteroplasty, the limited reports show that LMG ureteroplasty is safe and effective for the management of ureteral strictures. This method provides one more option for the management of long proximal and/or middle ureteral strictures. However, the current studies on LMG ureteroplasty have a small sample size and are retrospective. More prospective, multicenter and large sample studies with long-term follow-up results that can further prove the efficacy of LMG ureteroplasty are still needed.

Exposure of Urology Residents to the Management of Urethral Strictures in Saudi Arabia: Should the Program for Postgraduates Be Customized?

PurposeThis study aimed to assess the exposure and knowledge of urology residents in the management of urethral stricture (US) and to determine if they would be able to perform urethroplasty after graduation and whether urethroplasty should be included as a competency in the training program.Patients and MethodsAn online survey was sent to all residents enrolled in any urology training program in Saudi Arabia. Fifty-eight (approximately 50%) of the 114 residents who were sent the survey provided responses.ResultsMost of the residents (45 residents, 77.6%) who responded were exposed to fewer than ten cases of US during their last year of training. Fifty-six residents (96.6%) attended five or fewer urethroplasty procedures in their last year of training. Twenty-three (40%) residents did not attend any urethroplasty procedure in the last year. The most common procedures attended by the residents were minimally invasive treatments (89% cystoscopy with dilatation and 79% direct visual internal urethrotomy (DVIU)). Most residents responded that they would manage newly diagnosed 1 cm US with either cystoscopy and dilatation or with DVIU 53 (91%). For the first recurrence of US, 46 (79%) residents responded that they would still prefer dilatation or DVIU. For the second, third, and chronic recurrences of US, 20 (34.5%), 6 (10.3%), and 5 (8.6%) residents, respectively, responded that they would perform dilatation or DVIU. Residents had low expectations for the success rate of urethroplasty; only 32 (55.2%) residents thought it had a high success rate.ConclusionUrethroplasty is a specialized urological procedure, one that residents have variable exposure to. Privilege to perform such a procedure after graduating should be modified to ensure the best outcome for patients.

Urethrogram: Does Postoperative Contrast Extravasation Portend Stricture Recurrence?

To demonstrate our hypothesis that the presence of extravasation on postoperative urethrogram is inconsequential for disease recurrence in urethroplasty postoperative follow-up. We utilized the Trauma and Urologic Reconstructive Network of Surgeons database to assess 1691 patients who underwent urethroplasty and post-operative urethrogram. Anatomic and functional recurrence were defined as <17 Fr stricture documented at 12-month cystoscopy and need for a secondary procedure during 1 year of follow-up, respectively. Our primary outcomes were the sensitivity and positive predictive value of post-operative urethrogram for predicting anatomic and functional recurrence of urethral stricture disease. Among 1101 patients with cystoscopy follow-up, 54 (4.9%) had extravasation on initial postoperative urethrogram. Among those 54, 74.1% developed an anatomic recurrence vs 13% without extravasation (P <.001). Similarly, functional recurrence was 9.3% with extravasation vs 3.2 % without extravasation (P = .04). Patients with extravasation more often reported a postoperative urinary tract infection (12.9% vs 2.7%; P <.01) or wound infection (7.4% vs 2.6%; P = .04). Sensitivity of postoperative urethrogram in predicting any recurrence was 27.3%, specificity 98.7%, positive predictive value 77.8%, and negative predictive value 89.3%. Fourty-five of 54 patients with extravasation had a recurrence of some kind, equating to a 22.2% urethroplasty success rate at 1 year. Postoperative urethrogram has a high specificity but low sensitivity for anatomic and functional recurrence during short term follow-up. The positive predictive value of urinary extravasation is high: patients with extravasation incur a high risk of anatomic recurrence within 1 year and such patients may warrant increased monitoring.

MP35-04 DOES POST-OPERATIVE CONTRAST EXTRAVASATION PORTEND STRICTURE RECURRENCE? RESULTS FROM A MULTI-INSTITUTIONAL SURGICAL OUTCOMES RESEARCH GROUP

INTRODUCTION AND OBJECTIVE: Post-operative urethrogram is used to assess urethral healing after urethroplasty for urethral stricture disease (USD). The sequelae of post-operative contrast extravasation (CE) on post-operative urethrogram is unknown. We hypothesize urinary extravasation and presence of CE on post-operative urethrogram is inconsequential for disease recurrence. METHODS: We utilized the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) database to assess 1691 patients who underwent urethroplasty and post-operative urethrogram. Anatomic and functional recurrence were defined as < 17 Fr stricture documented at 12-month cystoscopy and need for a secondary procedure during follow-up, respectively. Our primary outcomes were the sensitivity and positive predictive value of post-operative urethrogram for predicting recurrence of USD. RESULTS: Among 1101 patients with cystoscopy follow-up, 54(4.9%) had contrast extravasation (CE) on initial post-operative urethrogram. Among those 54, 74.1% developed an anatomic recurrence versus 13% of patients without a CE (p<0.001). Similarly, functional recurrence was 9.3% with CE versus 3.2 % without CE (p=0.04). Patients with CE were more likely to report post-operative urinary tract infection (12.9% vs. 2.7%; p<0.01). Wound infection was reported in 7.4% vs. 2.6% for those with and without CE, respectively (p=0.04). When corrected by frequency of repair area itself, CE occurred in 15.9% of penile repairs, 13.3% of distal penile repairs, 8.5 % of repairs spanning more than one location and 3.0% of bulbar repairs. Sensitivity of post-operative urethrogram in predicting recurrence in this cohort was 27.3%, specificity 98.7%, positive predictive value (PPV) 77.8%, and negative predictive value (NPV) 89.3%. 45 of 54 patients with CE had a recurrence of some kind, equating to a 22.2% urethroplasty success rate for those with CE within 1 year. CONCLUSIONS: Based on these results we reject our initial hypothesis: Post-operative urethrogram has a high specificity but low sensitivity for recurrence during short term follow-up. Those with urinary extravasation incur a high risk of anatomic recurrence, in particular, and potentially such patients warrant increased monitoring.Source of Funding: None

Robotic-assisted Proximal Perineal Urethroplasty: Improving Visualization and Ergonomics

ObjectiveTo describe the use of the robotic platform for proximal suture placement during perineal urethroplasty in the posterior and proximal anterior urethra. Repair of posterior urethral and proximal bulbar strictures requires deep perineal dissection, making visualization and accurate placement of sutures challenging. The robotic platform has demonstrated benefits in these characteristics in deep pelvic surgery. MethodsWe report a retrospective review of 10 patients who underwent robotic-assisted urethroplasty at a single institution by a single surgeon in a 1 year period. All patients underwent a standard perineal dissection with robotic-assisted placement of proximal sutures. Postoperative outcomes include urethroplasty leak rate as determined by voiding cystourethrograms, urethroplasty success rate, and perioperative complications. ResultsThe mean age of this cohort was 43 years old (14-68). Average stricture length was 2.2 cm (1.5-3.0 cm) and most frequently in the bulbar urethra (5/10). Seven patients underwent nontransecting urethroplasties while 3 underwent transecting anastomotic repair. At postoperative voiding cystourethrograms, no patient had urinary extravasation. Average set-up time for the robotic portion of the surgery was 15 minutes with 30-45 minutes needed for suture placement. ConclusionRobotic-assisted urethroplasty provides excellent visualization and ergonomics for posterior and proximal bulbar urethral reconstruction. This is particularly helpful in patients with narrow pelvic anatomy and long distances from the perineal skin to the proximal urethral edge. Operative and postoperative outcomes are comparable to the standard approach with improved surgeon comfort and visualization. Additional follow-up is required to assess long-term outcomes in comparison to a standard approach.

Urethral Structure Length ≥ 2 cm is Significantly Associated with Lower Urethroplasty Success Rate, Results of our Large Case Series

Urethral Structure Length ≥ 2 cm is Significantly Associated with Lower Urethroplasty Success Rate, Results of our Large Case Series

Analysis of the donor site complications after long-strip lingual mucosal graft for the treatment of long-segment anterior urethral strictures in males

Objective To analyze the donor site complications of male patients with long segment anterior urethral strictures that underwent urethroplasty by using a long-strip lingual mucosal grafts (LMG) six months later. Methods Between August 2006 and December 2014, a total of 81 patients with long segment anterior urethral stricture underwent a procedure of urethroplasty using a long-strip LMG. The mean patients’ age was 41.2 years (range 18-74) and the mean urethral stricture length was 12.1 cm (range, 8-20 cm), a single LMG was more than 9 cm. Two techniques of urethroplasty were performed: One-sided dorsal graft augmentation urethroplasty was performed in 70 patients, 12 of the 70 patients underwent urethroplasty by using a LMG in addition to a BMG, owing to the presence of very long strictures; Dorsal patch graft urethroplasty was performed in 11 patients. Results Of the 81 patients a single long-strip LMG with length of 9-11 cm was used in 52 patients, LMG measured ≥12 cm in 17, and LMG combined with buccal mucosal graft (BMG) in 12. The mean follow-up period was 41 months (range, 15-86 months) postoperatively. The overall urethroplasty success rate was 82.7%. Six months after the operation, 28 patients (34.6%) reported a minimal to moderate difficulty in fine motor movement of the tongue (difficulty with spitting tiny fish bones). Among these 28, 22 patients (27.2 %) had associated numbness over the donor site, 10 patients (12.3%) had parageusia, and 11 patients (13.6%) reported slurring of speech. The donor site complications occurred higher in patients with LMG length≥12 cm (14/29) than those patients with LMG length<12 cm (14/52)(χ2=19.049, P<0.01). At 12 months, 5 patients (6.2%) reported minimal difficulty in fine motor movement of the tongue, and reduced to 1 patient at 24 months. Conclusions The donor side complications after long-strip lingual mucosal graft for the treatment of long-segment anterior urethral strictures are primarily limited to the first postoperative year, the incidence of complications appeared to be related to the length of the harvested graft. Key words: Lingual mucosa; Complication; Urethral stricture; Urethroplasty

Intermediate-Term Outcomes and Complications of Long Segment Urethroplasty with Lingual Mucosa Grafts

We evaluated outcomes and donor site complications in male patients with complex urethral strictures who underwent urethroplasty using with long strip oral mucosal grafts. We also analyzed whether a lingual mucosa graft is a good substitute for repairing long segment urethral strictures. This retrospective study was done in 81 male patients with complex urethral strictures who underwent oral mucosal graft urethroplasty. Patients with long segment (8 cm or greater) anterior urethral strictures who were considered candidates for long strip lingual mucosa graft urethroplasty were included in study. Oral mucosal graft urethroplasty was performed in 81 patients with complex urethral strictures between August 2006 and December 2014. Mean urethral stricture length was 12.1 cm (range 8 to 20). A single 9 to 12 cm long strip lingual mucosa graft was used in 52 patients, a lingual mucosa graft greater than 12 cm was placed in 17 and a lingual mucosa graft combined with a buccal mucosal graft was used in 12. Mean followup was 41 months (range 15 to 86) postoperatively. The overall urethroplasty success rate was 82.7%. Urethral complications developed in 14 patients (17.3%), including urethral strictures in 10 and urethrocutaneous fistulas in 4. At 12 months 5 patients (6.2%) reported minimal difficulty with fine motor movement of the tongue. Lingual mucosa harvested from the ventrolateral surface of the tongue can provide a wide and long graft that is an excellent urethral substitute. Donor site complications are primarily limited to postoperative year 1. Our study confirms that the lingual mucosa graft is a good substitute for urethral reconstruction and lingual mucosa graft urethroplasty is a valuable procedure to treat long anterior urethral strictures.

Analyse des taux de succès des urétroplasties pour sténoses de l’urètre bulbaire chez l’homme adulte : revue systématique de la littérature

The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra. We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required. From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36cm. Overall, 19/20 studies used buccal mucosal graft. The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture.

Harnröhrenstrikturen nach Strahlentherapie

Radiation-induced urethral stricture occurs most often due to radiation for prostate cancer. It is one of the most common side effects of radiotherapy. Stricture rates are lowest in patients undergoing external beam radiation therapy, occur more frequently in those who require brachytherapy and show highest stricture rates in patients receiving acombination of external beam radiation and brachytherapy. Strictures are mostly located at the bulbomembranous part of the urethra. Diagnostic work-up should include basic urologic work-up, ultrasound, uroflowmetric assessment, urethroscopy, retrograde urethrogram and voiding cystourethrography. Endoscopic management such as dilatation and internal urethrotomy has been proposed in short strictures. However these therapies have ahigh risk for recurrence. The success rate of urethroplasty is higher. Success rates of primary end-to-end anastomosis (EPA) have been reported to be 70-95 %; rates of incontinence are 7-40 %. While success rates of buccal mucosa graft urethroplasty (BMGU) range from 71-78 %, postoperative incontinence occurs in 10.5-44 %. Usually, postoperative incontinence can successfully be treated with an artificial urinary sphincter. It seems like EPA is the treatment of choice for short urethral strictures, whereas BMGU is indicated in longer, more complex strictures. Patients should be counselled with regard to length and location of strictures as well as with regard to postoperative incontinence.

PD16-01 UNDERSTANDING PATIENT PREFERENCES FOR SURGICAL MANAGEMENT OF URETHRAL STRICTURE DISEASE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2016PD16-01 UNDERSTANDING PATIENT PREFERENCES FOR SURGICAL MANAGEMENT OF URETHRAL STRICTURE DISEASE Lindsay A. Hampson, Tracy Lin, Leslie Wilson, Isabel Allen, Thomas Gaither, and Benjamin N. Breyer Lindsay A. HampsonLindsay A. Hampson More articles by this author , Tracy LinTracy Lin More articles by this author , Leslie WilsonLeslie Wilson More articles by this author , Isabel AllenIsabel Allen More articles by this author , Thomas GaitherThomas Gaither More articles by this author , and Benjamin N. BreyerBenjamin N. Breyer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1153AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral stricture disease has a substantial impact on quality of life and surgeons must understand how to best counsel patients about treatment options. We identified which treatment attributes are important to men making decisions about urethral stricture surgery and how prioritization of these attributes varies by patient characteristics. METHODS Male patients with urethral stricture disease participated in a choice-based conjoint analysis exercise with 18 treatment scenarios. Demographic, treatment, and symptom data were collected. Mixed effects logistic regression models were used to analyze patients' preferences and conduct subgroup analysis; a p-value of 0.05 was considered significant. RESULTS Participants had significant preferences within all treatment attributes except recovery time, preferring higher success rate, decreased catheter duration, fewer future procedures, open reconstruction, and lower copayment (Fig1). Based on calculated relative attribute preferences, treatment success rate was the most important attribute, followed by copayment, future procedures, duration of catheterization, type of procedure, and, lastly, recovery time (Fig1). In subgroup analysis, older patients had stronger dislike for a 25% success rate and for additional procedures compared to younger patients, while lower income patients had stronger negative preferences towards higher copayments compared to higher income patients. Patients who previously underwent surgical treatment showed no differences in treatment preferences compared to those who had not. CONCLUSIONS Treatment success rate is the most important treatment attribute, suggesting that patients should be strongly counseled about expected success rates of urethroplasty and urethrotomy. Based on subgroup analysis, doing a ′′less invasive′′ urethrotomy for older patients may not be preferable given the lower success rate and higher chance of future procedures. Costs related to care are meaningful to lower income patients, even eclipsing the importance of success rates at high copayment costs. These results can help urologists' improve patient-centered outcomes through better treatment counseling and determination of optimal management based on patients' characteristics. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e394 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Lindsay A. Hampson More articles by this author Tracy Lin More articles by this author Leslie Wilson More articles by this author Isabel Allen More articles by this author Thomas Gaither More articles by this author Benjamin N. Breyer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

90 OUTCOME OF CONTEMPORARY URETHROPLASTY AT A TERTIARY CARE CENTER

INTRODUCTION AND OBJECTIVES: To evaluate the stricture free survival rate, adverse events and quality of life (QoL) of urethroplasty in the short term follow-up. METHODS: We retrospectively evaluated our patients who underwent urethroplasty between 12/08 and 07/10 at the University Medical Center Hamburg-Eppendorf, Germany. A standardized nonvalidated questionnaire was sent to all patients in September 2010. Primary end point was the stricture free survival rate, defined as no stricture recurrence. Secondary endpoints were adverse events and QoL. RESULTS: Within 19 months 205 patients underwent urethroplasty due to urethral stricture at different localisations and extend. One hundred forty four patients (70%) with a mean age of 56 years (range 14–84) and a mean follow up of 10.2 months (1–22), responded to our questionnaire. Of this cohort 9%, 85% and 6% were treated by primary excision and re-anastomosis (EPA), buccal mucosa graft (BMG) and mesh graft (MG) urethroplasty, respectively. Overall, 18/144 (12.5%) recurrences were documented and specifically 0%, 14.3% and 12.5 % for EPA, BMG and MG. In Kaplan Meier analysis there was no statistical significant difference concerning the stricture recurrence free survival between the three surgical techniques. Furthermore, no risk factor as localisation, stricture length and number of previous surgeries was identified for early stricture recurrence. Adverse events as incontinence, curvature, shortening and post void wiping out of the urethra were most often associated with MG urethroplasty. However, statistical significant difference was not shown (p 0.05). Neither, there was a statistical significant difference found in QoL nor satisfaction with surgical outcome between the three techniques of urethroplasty (p 0.7). CONCLUSIONS: At our center contemporary urethral surgery signifies a BMG for the majority of patients. Stricture recurrence free survival for EPA, BMG and MG seems comparable. However, EPA demonstrates excellent success rates of urethroplasty in the short term follow up. Differences in adverse events are not statistically significant between EPA, BMG and MG and do not seem to have an impact on quality of life and satisfaction of surgical outcome.

Die plastische Rekonstruktion der Harnröhre

There is no technique which can be used in all types and localizations of urethral strictures. Urethral strictures occur in the majority of cases in the bulbar urethra. The success rate of urethroplasty is above 80% and results are much better compared to DVIU. Dorsal onlay shows a significantly better success rate than ventral onlay. If the graft bed has poor vascularization a flap should be used or a staged approach should be considered.

A Technique of Anterior Urethroplasty Using the Tunica Albuginea of the Corpora Cavernosa

Objective To describe a technique of anterior urethroplasty using the tunica albuginea of the corpora cavernosa. Methods We performed this technique on 99 male patients with anterior urethral stricture with follow-up at 6, 12 and 18 months. We assessed preoperative and postoperative patient satisfaction rate based on symptoms along with preoperative and postoperative urethrograms, urethrosonographies and uroflowmetry and labelled outcomes as good, fair and poor. Results Good and fair results were considered successful. The overall success rate was 95.9%. In our series of patients, the overall success rate of urethroplasty remained the same at 6 months, but decreased to 94.9% at 12 months and 88.1% at 18 months. Conclusion These observations show that anterior urethroplasty by using the tunica albuginea of the corpora cavernosa produced satisfactory results and is comparable with the other techniques of urethroplasty. The merits of using the tunica albuginea for urethroplasty are local availability of tissues, so that there is no need to use anatomically and structurally dissimilar distant tissue such as the buccal mucosa, preputial, penile, or scrotal skin or Teflon grafts. It can be used in our area where most of the patients come with dyskeratotic changes in their buccal mucosa.

Factors Contributing to a Successful Outcome of Combined Abdominal Transpubic Perineal Urethroplasty for Complex Posterior Urethral Disruptions

We present our results of and operative principles essential for a successful outcome of complex posterior urethral disruption management. A total of 25 patients underwent abdominal transpubic perineal urethroplasty for complex posterior urethral disruption. Preoperative voiding cystourethrogram with retrograde urethrogram and cystourethroscopy were done to evaluate the stricture and bladder neck. Followup consisted of symptomatic and radiological assessment. Patient age was 22 to 57 years. Average followup was 24 months (range 11 to 39). Four patients had previously undergone failed perineal urethroplasty. A rectourethral fistula was present in 8 patients, of whom 2 required colonic diversion, while there were false passages in 3, a periurethral cavity with abscess in 6 and bladder neck laceration in 20. Mean stricture length +/- SD was 6.5 +/- 2.5 cm (range 4 to 9). Four of the 25 patients had previously undergone failed perineal urethroplasty. The mean period between original trauma/failed repair and definitive repair was 11.5 +/- 4.4 months. Urethroplasty could be achieved through the normal subpubic route in 19 patients, while 6 required supracrural rerouting. A total of 20 patients underwent simultaneous bladder neck repair. In 24 of 25 patients (96%) postoperative cystourethrography showed a wide, patent anastomosis. Postoperatively incontinence developed in 1 of 25 patients (4%). Ten of the 25 patients (40%) were impotent after the primary injury. Potency status in our patients did not change after urethroplasty. The overall urethroplasty success rate was 92%. Hostile conditions in the perineum of patients with complex posterior urethral disruption mitigate against a good result. However, the safety and success of combined abdominal transpubic perineal urethroplasty make it the procedure of choice for these difficult strictures.

Long-term Results of Surgery For Urethral Stricture: A Statistical Analysis

We assessed the long-term results of surgery for urethral stricture by statistical methods using guidelines for survival analysis. Of the 267 patients who underwent surgery for urethral strictures between March 1993 and December 1999, 238 (89%) were followed prospectively. The primary end point was success rate of urethroplasty. Secondary end points were variables that might influence success rates. Survival data were analyzed by the Kaplan-Meier method and Cox regression using guidelines for survival analysis. The success rate of all urethroplasties was 82% (95% CI 66 to 89) at 7.5 years. A 6.5-year success rate of 86% (95% CI 70 to 95) was achieved by flap, of 86% (95% CI 66 to 100) by anastomotic, of 79% (95% CI 64 to 94) by mesh graft and of 56% (95% CI 20 to 100) by graft urethroplasty. No significant difference was found among the surgical procedures using the log rank (p = 0.269) or Gehan-Wilcoxon (p = 0.259) test. Multivariate analysis showed an increased risk of failed urethroplasty in patients previously treated with urethral stents (HR 3.69, 95% CI 1.27 to 10.8) and by 2 or more urethrotomies (HR 2.25, 95% CI 1.05 to 4.8). Using standardized success criteria and statistical methods that applied guidelines for survival analysis conclusions were drawn. Excellent results are achievable by all forms of urethroplasty, justifying a more liberal indication for urethral reconstruction.