Reconstructive UrologyChanging Trends in Reconstruction of Complex Anterior Urethral Strictures: From Skin Flap to Perineal Urethrostomy
Section snippets
Materials and Methods
We performed an institutional review board approved retrospective study of male patients undergoing complex urethral reconstruction for stricture by a single surgeon at our tertiary academic referral center between 2007 and 2017. All patients had symptomatic urethral stricture, characterized by obstructive voiding symptoms, urinary retention and/or recurrent urinary tract infections and diagnosed on retrograde urethrography and/or cystoscopy. Focal and uncomplicated strictures amenable to
Patient and Stricture Characteristics
Among 1129 urethral strictures undergoing reconstructive surgery, 403 complex strictures meeting inclusion criteria were analyzed (median length 4.5 cm) and are summarized in Table 1. Reconstruction was most commonly performed using BMG (247/403, 61.3%), followed by penile skin flap (87/403, 21.6%) and PU (77/403, 19.1%). Among the BMG cases, 70.4% were single-stage repairs (174/247), while two-stage repairs were less common (73/247, 29.6%).
Although median age overall was 53.2 years (standard
Discussion
Our reconstructive approach for complex urethral stricture has gradually changed over the last decade to reflect emerging evidence and refinements in technique. Although BMG continues at a stable rate, accounting for nearly two-thirds of complex cases, penile skin flap became less common and PU use rose dramatically. Successful outcome without need for additional intervention remained nearly universal following PU, compared to BMG and penile skin flap techniques, which were successful only
Conclusion
Over a decade of a urethral reconstructive practice, PU has increasingly become preferred for older patients with long strictures and adverse etiology. BMG urethroplasty rates remain stable, while penile skin flap use is decreasing. Success rates of PU for complex strictures are markedly higher than those of grafts and flaps.
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Cited by (22)
Proximal Urethrostomy Versus Urethroplasty for Complex Urethral Strictures
2024, European Urology Open ScienceSimplified urethral score system for predicting complex anterior urethroplasty
2022, Actas Urologicas EspanolasOutcomes of perineal urethrostomy for penile cancer: A 20-year international multicenter experience
2021, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :However, these (small) studies may not apply to penile cancer patients as they were performed for benign disease (urethral strictures), and no simultaneous total penectomy was required, possibly explaining the lower reported complication rates. Regarding PU stenosis rates, our results are similar to other PU series of benign urethral pathology with failure rates ranging from 5% to 22% [4,5,22,24]. We acknowledge the significant limitations of our study.
Extended Primary Anastomosis With Penile Plication (EPAPP): A Promising New Alternative to Perineal Urethrostomy for Reconstruction of Long Urethral Strictures
2021, UrologyCitation Excerpt :We did not consider nontransecting anastomotic techniques in the present cohort due to (a) the length and severity of the urethral pathology, and (b) lack of interest in sexual activity. In the setting of complex or recurrent anterior urethral stricture disease, perineal urethrostomy (PU) remains an effective – if underutilized – approach, especially for patients of advanced age or with significant comorbidities.26 Although many patients are initially reluctant to consider this option due to loss of standing voiding and ejaculatory functionality, patient satisfaction rates as high as 97% have been reported.27
EDITORIAL COMMENT
2020, UrologyAUTHOR REPLY
2020, Urology
Financial Disclosure: Dr. Allen Morey receives honoraria for being a guest lecturer/meeting participant for Boston Scientific. The remaining authors declare that they have no relevant financial interests.