the New England Section of the American Urological Association the New England Section of the American Urological Association
Search Meeting Site Only
Annual Meeting Home
Preliminary Program
Allied Health Program
Past & Future Meetings
 

Back to Annual Meeting Program


Management of complex long, anterior urethral strictures: outcomes analysis.
Jessica DeLong, MD, Jill Buckley, MD.
The Lahey Clinic, Burlington, MA, USA.

BACKGROUND:
Long, complex anterior urethral strictures represent a challenging problem for the reconstructive urologist. We present our series of long, greater than 8cm anterior urethral strictures.
METHODS:
We queried our IRB-approved database between May 2008 and January 2011 to identify patients with long, 8 cm or greater strictures who underwent urethroplasty at our institution. Patients were excluded if they did not undergo formal reconstruction. All patients were evaluated preoperatively, at 3, 6 and 12 months postoperatively, then yearly thereafter. Operative and perioperative data was collected, including International index of erectile function (IIEF), quality of life (QOL) and AUA symptom score (AUASS).
RESULTS:
We identified 22 patients who underwent urethral reconstruction for long anterior urethral stricture over the study time period. An additional 3 patients underwent perineal urethrostomy and were excluded from analysis. Mean patient age was 51 (range 30-72) years. Average stricture length was 11.5 (range 8-15) cm. Four patients with devastated urethras underwent staged urethroplasty. Fifteen patients required harvesting of bilateral buccal mucosal grafts with one patient needing additional graft from the lip. Four patients underwent a dorsal onlay with augmented ventral anastomosis. One patient underwent a fasciocutaneous flap, and one patient underwent only first stage urethroplasty. Mean follow up was one year. Overall there was no difference in preoperative vs postoperative IIEF (p=0.25). Mean improvement in QOL score was 3 (p<0.05), mean improvement in AUASS was 11 (p<0.05). Postoperative flow was improved by an average of 12cc/second (p<0.05). Four patients required subsequent DVIU due to graft narrowing, one of whom required additional urethroplasty.
CONCLUSIONS:
Patients with long, complex anterior urethral strictures can have successful reconstruction with excellent outcomes and significant improvements in QOL measures, thereby avoiding the life-long consequences of severe urethral stricture disease.
Table 1
Age years (range)51 (30-72)
Etiology12 unknown
6 lichen sclerosis
1 hypospadias cripple
1 iatrogenic
1 urethral amyloidosis
1 trauma
Stricture length cm (range)11.5 (8-15)
>= 5 prior endoscopic procedures9
Performing CIC5
Indwelling Foley or SPT5
Recurrent UTI5


Back to Annual Meeting Program

 


© 2018 New England Section of the American Urological Association. All Rights Reserved. Privacy Policy.