A Multi-institutional Evaluation of the Management and Outcomes of Long-segment Urethral Strictures. Journal Article

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Authors: Warner, JN; Malkawi, I; Dhradkeh, M; Joshi, PM; Kulkarni, SB; Lazzeri, M; Barbagli, G; Mori, R; Angermeier, KW; Storme, O; Campos, R; Velarde, L; Gomez, RG; Han, JS; Gonzalez, CM; Martinho, D; Sandul, A; Martins, FE; Santucci, RA
Article Title: A Multi-institutional Evaluation of the Management and Outcomes of Long-segment Urethral Strictures.
Abstract: OBJECTIVE: To evaluate the treatment options and surgical outcomes of long-segment urethral strictures-a review of the largest, international, multi-institutional series. METHODS: A retrospective review was performed of patients treated with strictures =8 cm at 8 international centers. Endpoints analyzed included surgical complications and recurrence. RESULTS: Four hundred sixty-six patients were identified. Treatment intervals ranged from December 27, 1984 to November 9, 2013. Dorsal onlay buccal mucosal graft (BMG) was the most common procedure (223, 47.9%); others included first- and second-stage Johanson urethroplasty (162 [34.8%] and 56 [12%], respectively), fasciocutaneous (FC) flaps (8, 1.7%), and a combination flap and graft (17, 3.6%). Overall success was achieved in 361 patients (77.5%) with a mean follow-up of 20 months. Second-stage Johanson urethroplasty was found to have a higher recurrence rate compared with that of 1-stage BMG urethroplasty (35.7% vs 17.5%, respectively; P .01). This was also true in cases of lichen sclerosus (14.0% vs 47.8%, respectively; P .01). Otherwise, success rates were similar. Urethroplasties performed with FC flaps had a higher complication rate compared with those without (32% vs 14%, respectively; P = .02). Prior dilation or urethrotomy, higher number of prior dilations or urethrotomies, abnormal voiding cystourethrogram, and skin grafts all portend a higher recurrence rate. On logistic regression analysis, only second-stage Johanson had an increased odds ratio of recurrence compared with that of BMG (2.82 [1.41-5.86]). CONCLUSION: Long-segment strictures can be treated with high success rates in experienced hands. BMG was more successful than second-stage Johanson urethroplasty. FC flaps, although successful, had high complication rates.
Journal Title: Urology
ISSN: 1527-9995; 0090-4295
Publisher: Elsevier Inc  
Date Published: 2015