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• W3033610707 abstract "No AccessJournal of UrologyAdult Urology1 Nov 2020Augmented Anastomotic Urethroplasty is Independently Associated with Failure after Reconstruction for Long Bulbar Urethral StricturesThis article is commented on by the following:Editorial CommentEditorial Comment Elaine J. Redmond, Dylan T. Hoare, and Keith F. Rourke Elaine J. RedmondElaine J. Redmond Division of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author , Dylan T. HoareDylan T. Hoare Division of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author , and Keith F. RourkeKeith F. Rourke *Correspondence: Division of Urology, Department of Surgery, University of Alberta, 7th Floor, Kaye Edmonton Clinic, 11400 University Ave., Edmonton, Alberta T6G-1Z1 telephone: 780-407-5800; FAX: 780-441-2597; E-mail Address: [email protected] Division of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001177AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Controversy exists regarding the optimal urethroplasty technique, particularly for long bulbar urethral strictures requiring buccal mucosal graft. We assessed the relative outcomes of augmented anastomotic urethroplasty vs dorsal onlay in the setting of bulbar urethroplasty using a dorsal buccal mucosal graft. Materials and Methods: A retrospective review was performed on all patients who underwent bulbar urethroplasty with dorsal buccal mucosal graft between October 2003 and March 2019. Around 2011 institutional technique shifted from routinely performing transecting augmented anastomotic urethroplasty to nontransecting dorsal onlay. Anastomotic urethroplasty without buccal mucosal graft, ventral onlay, staged, flap and circumferential reconstructions were excluded. The primary outcome was stricture recurrence defined as less than 16Fr on cystoscopy. Secondary outcomes included 90-day complications and de novo erectile dysfunction at 6 months. Results: Of the 836 patients who underwent bulbar urethroplasty during the study period 507 met inclusion criteria. Of these, 221 patients received an augmented anastomotic urethroplasty while 286 underwent dorsal onlay urethroplasty. Mean patient age and stricture length were 45.4±14.8 years and 4.4±1.5 cm, respectively. Overall success rate was 93.9% (476 of 507) with a mean followup of 78.9 months. On multivariate analysis augmented anastomotic urethroplasty (HR 4.8, p=0.002), increasing stricture length (HR 1.2, p=0.002) and iatrogenic strictures (HR 3.2, p=0.03) were independently associated with stricture recurrence, while comorbidity (p=0.06), prior endoscopic treatment (p=0.41), prior urethroplasty (p=0.89) and other etiologies were not. There was no difference between cohorts with respect to Clavien 2 or greater complications (3.6% vs 4.2%, p=0.74) or de novo erectile dysfunction (5.9% vs 5.6%, p=0.89). Conclusions: Augmented anastomotic urethroplasty is independently associated with stricture recurrence when compared to a pure dorsal onlay technique. References 1. : History of urethral stricture and its treatment. In: Textbook of Male Genitourethral Reconstruction. . Cham, Switzerland: Springer 2020; p 3. Google Scholar 2. : Substitution urethroplasty for bulbar urethral strictures. In: Textbook of Male Genitourethral Reconstruction. . Cham, Switzerland: Springer 2020; p 191. Google Scholar 3. : What is the best technique for urethroplasty?Eur Urol 2008; 54: 1031. Google Scholar 4. : The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol 2001; 165: 1496. Link, Google Scholar 5. : Augmented anastomotic urethroplasty. J Urol 2007; 177: 2211. Link, Google Scholar 6. : The nontransecting approach to bulbar urethroplasty. Urol Clin 2017; 44: 57. Google Scholar 7. : Analysis of the factors involved in the failure of urethroplasty in men [in English, Spanish]. Actas Urol Esp 2014; 38: 96. Google Scholar 8. : SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology, suppl., 2014; 83: S31. Google Scholar 9. : A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol 2011; 59: 797. Google Scholar 10. : Stricture recurrence after urethroplasty: a systematic review. J Urol 2009; 182: 1266. Link, Google Scholar 11. : Long-term followup of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol 2007; 178: 2470. Link, Google Scholar 12. : Non-transecting bulbar urethroplasty is favored over transecting techniques. World J Urol 2019; doi: 10.1007/s00345-019-02867-8. Crossref, Google Scholar 13. : Nontransecting techniques reduce sexual dysfunction after anastomotic bulbar urethroplasty: results of a multi-institutional comparative analysis. J Urol 2019; 201: 364. Link, Google Scholar 14. : A morphometric analysis of bulbar urethral strictures. BJU Int 2007; 100: 397. Google Scholar 15. : The augmented anastomotic urethroplasty. In: Advanced Male Urethral and Genital Reconstructive Surgery. . New York, New York: Humana Press 2014; p 212. Google Scholar 16. : Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. Eur Urol 2008; 53: 1162. Google Scholar 17. : Sexual dysfunction after urethroplasty. Urol Clin 2017; 44: 49. Google Scholar 18. : Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: a multivariate analysis of 604 urethroplasties. Can Urol Assoc J 2014; 8: E296. Google Scholar 19. : Multivariate analysis of risk factors for long-term urethroplasty outcome. J Urol 2010; 183: 613. Link, Google Scholar 20. : Long-term results of internal urethrotomy. J Urol 1996; 156: 1611. Link, Google Scholar 21. : A multi-institutional evaluation of the management and outcomes of long-segment urethral strictures. Urology 2015; 85: 1483. Google Scholar 22. : Risk of urethral stricture recurrence increases over time after urethroplasty. Int J Urol 2015; 22: 695. Google Scholar 23. : Longterm outcome of urethroplasty after failed urethrotomy versus primary repair. J Urol 2001; 165: 1918. Link, Google Scholar 24. : Revision urethroplasty success is comparable to primary urethroplasty: a comparative analysis. Urology 2014; 84: 928. Google Scholar 25. : Independent predictors of stricture recurrence following urethroplasty for isolated bulbar urethral strictures. J Urol 2017; 198: 1107. Link, Google Scholar 26. : Cigarette smoking decreases tissue oxygen. Arch Surg 1991; 126: 1131. Google Scholar 27. : Does tobacco consumption influence outcome of oral mucosa graft urethroplasty?Urol J 2010; 7: 45. Google Scholar 28. : The impact of age on urethroplasty success. Urology 2017; 107: 232. Google Scholar 29. : Assessment of the male urethral reconstruction learning curve. Urology 2016; 89: 137. Google Scholar 30. : Describing the learning curve for bulbar urethroplasty. Transl Androl Urol 2017; 6: 1132. Google Scholar No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor’s Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1104 and 1105. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySmith J (2020) This Month in Adult UrologyJournal of Urology, VOL. 204, NO. 5, (895-896), Online publication date: 1-Nov-2020.Related articlesJournal of UrologyAug 28, 2020, 12:00:00 AMEditorial CommentJournal of UrologyAug 28, 2020, 12:00:00 AMEditorial Comment Volume 204Issue 5November 2020Page: 989-995Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsrisk factorsurethral stricturerecurrenceMetricsAuthor Information Elaine J. Redmond Division of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author Dylan T. Hoare Division of Urology, University of Alberta, Edmonton, Alberta, Canada More articles by this author Keith F. Rourke Division of Urology, University of Alberta, Edmonton, Alberta, Canada *Correspondence: Division of Urology, Department of Surgery, University of Alberta, 7th Floor, Kaye Edmonton Clinic, 11400 University Ave., Edmonton, Alberta T6G-1Z1 telephone: 780-407-5800; FAX: 780-441-2597; E-mail Address: [email protected] More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor’s Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1104 and 1105. Advertisement Loading ..." @default.
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• W3033610707 title "Augmented Anastomotic Urethroplasty is Independently Associated with Failure after Reconstruction for Long Bulbar Urethral Strictures" @default.
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