Analysis of a 7‐year national online audit of the management of open reconstructive urethral surgery in men

Abstract

ObjectiveTo conduct an audit of the management of urethral pathology in men presenting for reconstructive urethral surgery in the UK. MethodsBetween 1 June 2010 and 31 May 2017, data on men presenting with urethral pathologies requiring reconstruction were entered onto a secure online data platform. Surgeonentered information was collected in 95 fields regarding the stricture aetiology, prior management, mode of presentation, type of surgery and outcomes, with a potential 283 variable responses in the 95 fields. Data were analysed to compare UK practice with that reported in the contemporary literature and with guidelines. ResultsData on 4809 men were entered by 39 centres and 50 surgeons. Field completeness was 70.7%, 74.3% and 53.7% for preoperative, operative and follow-up data, respectively. Referral for stricture reconstruction frequently followed two prior endoscopic procedures and the stricture was not always assessed anatomically before surgery. Urinary retention was a common symptom in men awaiting reconstruction. Short unifocal strictures of the anterior urethra were the commonest reason for referral, whilst lichen sclerosus and hypospadias generated a significant volume of revisional stricture surgery. Lower numbers of very complex interventions are required for the management of posterior urethral pathology. Although precise criteria for determining success are not clear, management of urethral reconstruction in the UK was found to have a low risk of Clavien-Dindo grade 3 or higher complications, and was associated with outcomes similar to those reported in contemporary series except in the management of posterior urethral fistulae. ConclusionsOnline databases can provide volume data on the management of reconstructive urethral surgery across a multiplicity of centres in one country. They can also indicate compliance with accepted standards of, and expected outcomes from, this tertiary practice.

The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery

“…Information about post-operative complications, and the risks of stricture, fistula recurrence, or failed hypospadias repair, facilitates the definition of a number of patient subpopulations. 5 These can be stratified as either high-, intermediate- or low-volume or risk procedures, dependent upon their frequency of presentation, chance of complication, risk of failure or need for reintervention (Table 4).…”

“…Surgeon-derived data obtained from the online, encrypted Nuvola/Dendrite software system, previously described, 5 were analysed over a 7-year period from June 2010 to June 2017. Data were collected about where, when and by whom data were entered, from a series of single options and free-text strings, in 95 fields with 283 variables.…”

“…By comparison, detailed clinically derived data, accrued from the British Association of Urological Surgeons (BAUS) 7-year longitudinal audit of tertiary reconstructive urology, 5 has provided much greater, clinically relevant insight into the volumes and outcomes of patients having reconstructive urethral surgery in the UK. The BAUS data sets facilitate the delineation of high-volume low-risk patient populations, and the identification of intermediate- and low-volume and moderate- to high-risk groups, who may require more specialist reconstructive interventions to try and achieve better long-term outcomes.…”

“…The BAUS data sets facilitate the delineation of high-volume low-risk patient populations, and the identification of intermediate- and low-volume and moderate- to high-risk groups, who may require more specialist reconstructive interventions to try and achieve better long-term outcomes. This paper seeks to integrate the incident urethral pathologies and their outcomes from reconstruction 5 with the surgical services currently available, so as to define volume/risk populations and an acceptable, best fit structure for future service delivery of urethral reconstruction.…”

Editorial Comment: Management of post TURP strictures

“…Trans-urethral prostate resection (TURP) is one of the most common urologic surgeries and the urethral stricture is an important complication ( 1 ). In the present paper Dr. Kulkarni, in a prospective study with 170 patients shows that bulbar stricture is the most frequent affected area with stricture post TURP (143 patients) and that buccal mucosa graft (BMG) is safe, feasible and with long-term success in these patients that should be strongly considered.…”