Assessing in-hospital morbidity after urethroplasty using the European Association of Urology Quality Criteria for standardized reporting

Accurately Defining the Incidence and Associations of 90-Day Complications after Urethroplasty: Adverse Impact of Patient Comorbidities, Preoperative Bacteriuria and Prior Urethroplasty

“…This finding is somewhat lower than reported rates of 4.0%–6.9% found in other series. 14,16–20 Nonetheless, this finding confirms UTI is one of the most common postoperative infections with a most probable incidence of 3%–6%, especially when considering the high proportion of patients with stricture who present with a history of UTI, bacteriuria or indwelling catheter. 2,3…”

“…Data describing the rates and types of complications following urethroplasty have been inconsistent. 13–21 To ensure patients are well informed as part of a shared decision-making model of care it is imperative that the complications of urethroplasty are well delineated. In addition to patient morbidity, when complications arise in the perioperative period they substantially limit the cost-effectiveness of urethroplasty.…”

“…While the score itself is nonspecific in describing specific patient etiologies or explaining mechanisms for emergence of complications, increased patient comorbidity has been associated with urethroplasty complications in other series that report this measure. 15,17 In particular, patients with a CCI comorbidity component of 3 or more appear to be at increased risk of 90day complications. Active smoking and diabetes were not found to be significant contributors to complications in our series despite their known adverse effect on vasculature and wound healing.…”

“…Diabetes, age, history of radiotherapy, increased patient comorbidities, African American ethnicity, preoperative blood transfusion, preoperative sepsis, low hematocrit, low albumin, substitution urethroplasty, perineal urethrostomy, longer operative times and surgical complexity have all been identified as potential factors associated with an increased risk of complications. 13–21 These discrepancies may also be related to the observation that the majority of studies are either from small, single-center series or larger population based studies lacking granular preoperative patient demographics and lack followup outside of the inpatient timeframe. Thus, it is difficult to draw meaningful conclusions from the existing literature.…”

Graft Plus Fasciocutaneous Penile Flap for Nearly or Completely Obliterated Long Bulbar and Penobulbar Strictures

“…Double face grafting requires a large amount of buccal mucosa, which is frequently unavailable in redo cases; moreover, the grafts need healthy edges of an existing urethral plate to be anastomosed, which is by definition absent in an obliterative stricture. Finally, multistage or definitive perineal urethrostomy is associated with high morbidity and considerable discomfort for the patient [6] . Over a time of 4 yr, we have refined our technique of graft plus flap substitution urethroplasty for patients with long (>4 cm) segments of urethral loss involving the bulbar and/or the penile urethra.…”