Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence

Abstract

Purpose To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence. Methods We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success. Results Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3–17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6–240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months. Conclusion Staged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.

Onlay Pedicled Transverse Skin Flap versus One-Stage Inlay Buccal Mucosal Graft in Penile Urethroplasty: A Prospective Matched-Pair Analysis

“…As our study cohort is rather small, however, and as there were solely 3 patients (6.8%) who had received a prior urethral dilation, we certainly refrain from drawing any definitive conclusions. The risk factors most commonly described by previous series (age, stricture length, body mass index [24][25][26]) were not found to be statistically significant in our analysis.…”

“…With regard to risk factors for stricture recurrence, the only statistically significant association we found was that patients who had received a prior urethral dilation, when compared to patients with no previous surgery or previous VIU, were less likely to develop a stricture recurrence (p = 0.018). As this association has not yet been reported by previous series [1,[12][13][14][15][24][25][26], we have to assume it is a statistically significant effect without clinical relevance. As our study cohort is rather small, however, and as there were solely 3 patients (6.8%) who had received a prior urethral dilation, we certainly refrain from drawing any definitive conclusions.…”

Staged urethroplasty with groin full-thickness skin graft for managing complex anterior urethral strictures: surgical outcomes and predictive factors

“…A recent study showed a zero rate of re-grafting and an early success rate of 100.0% at 4-months after staged urethroplasty using thigh split-thickness skin graft (STSG) or BMG [ 3 ]. However, the long-term success rate of the study was only 53.0% in patients with a follow-up duration of > 1 year after staged urethroplasty using STSG [ 3 ]. Thus, STSG has a problem with durability.…”

Update on the management of penile and meatal strictures

“…Given that the patient series from the mentioned review was hampered by relatively short follow-up, more contemporary reports seem to reflect a more realistic estimation for staged repairs. In a recent series from the United States, Furr et al evaluated all of their patients with penile strictures who underwent staged urethroplasty [30 ▪▪ ]. All men had the lack of an intact corpus spongiosum in common, and the urethral plate could not be mobilized and augmented with a single-stage technique.…”