Repeat Urethroplasty After Failed Urethral Reconstruction: Outcome Analysis of 130 Patients
Abstract
Purpose:
Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment for urethral strictures, fewer studies have addressed the treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We examined outcome results for repeat urethroplasty.
Materials and Methods:
A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with repeat urethroplasty after failed prior urethral reconstruction. Stricture length and location, and repeat urethroplasty intervention and failure were evaluated with descriptive statistics, and univariate and multivariate logistic regression.
Results:
Of 1,156 cases 168 patients underwent repeat urethroplasty after at least 1 failed prior urethroplasty. Of these patients 130 had a followup of 6 months or more and were included in analysis. Median patient age was 44 years (range 11 to 75). Median followup was 55 months (range 6 months to 20.75 years). Overall, 102 of 130 patients (78%) were successfully treated. For patients with failure median time to failure was 17 months (range 7 months to 16.8 years). Two or more failed prior urethroplasties and comorbidities associated with urethral stricture disease were associated with an increased risk of repeat urethroplasty failure.
Conclusions:
Repeat urethroplasty is a successful treatment option. Patients in whom treatment failed had longer strictures and more complex repairs.
References
- 1 : Male urethral stricture disease. J Urol2007; 177: 1667. Link, Google Scholar
- 2 : Outcome of dorsal buccal graft augmented anastomosis for urethral strictures after a failed reconstruction. J Urol2011; 185: e2. Link, Google Scholar
- 3 : Perineal anastomotic urethroplasty for posttraumatic urethral stricture with or without previous urethral manipulations: a review of 61 cases with long-term followup. J Urol2009; 181: 1196. Link, Google Scholar
- 4 : Urethral strictures. BJU Int2011; 107: 6. Google Scholar
- 5 : Etiology of urethral stricture disease in the 21st century. J Urol2009; 182: 983. Link, Google Scholar
- 6 : Long-term efficacy of distal penile circular fasciocutaneous flaps for single stage reconstruction of complex anterior urethral stricture disease. J Urol2008; 179: 2259. Link, Google Scholar
- 7 : Multivariate analysis of risk factors for long-term urethroplasty outcome. J Urol2010; 183: 613. Link, Google Scholar
- 8 : Urethrotomy has a much lower success rate than previously reported. J Urol2010; 183: 1859. Link, Google Scholar
- 9 : Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol2002; 167: 1715. Link, Google Scholar
- 10 : Straddle injuries to the bulbar urethra: management and outcomes in 78 patients. J Urol2004; 171: 722. Link, Google Scholar
- 11 : Urethral reconstruction for traumatic posterior urethral disruption: outcomes of a 25-year experience. J Urol2007; 178: 2006. Link, Google Scholar
- 12 : Stricture recurrence after urethroplasty: a systematic review. J Urol2009; 182: 1266. Link, Google Scholar
- 13 : Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol2007; 178: 2470. Link, Google Scholar
- 14 : Urethroplasty for failed hypospadias repair: a matched cohort analysis. J Pediatr Urol2011; 7: 170. Google Scholar
- 15 : Complicated urethroplasty: a guide for surgeons. Nat Rev Urol2010; 7: 521. Google Scholar
- 16 : Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men. Cochrane Database Syst Rev2010; 4. CD006934. Google Scholar
- 17 : Repeat urethrotomy and dilation for the treatment of urethral stricture are neither clinically effective nor cost-effective. J Urol2004; 172: 275. Link, Google Scholar
- 18 : Cost-effective approach to short bulbar urethral strictures supports single internal urethrotomy before urethroplasty. J Urol2009; 181: 954. Link, Google Scholar
Department of Urology, University of California-San Francisco, San Francisco, California
