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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) | | Etiology | 12 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 procedures | 9 | | Performing CIC | 5 | | Indwelling Foley or SPT | 5 | | Recurrent UTI | 5 |
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