Guido Barbagli1, Sanjay B Kulkarni2, Nicola Fossati3, Alessandro Larcher3, Salvatore Sansalone4, Giorgio Guazzoni3, Giuseppe Romano1, Joshi M Pankaj2, Vincenzo Dell'Acqua3, Massimo Lazzeri5. 1. Center for Reconstructive Urethral Surgery, Arezzo, Italy. 2. Centre for Reconstructive Urology, Pune, India. 3. Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy. 4. Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy. 5. Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy. Electronic address: lazzeri.maximus@gmail.com.
Abstract
PURPOSE: We investigated deterioration of the success rate of penile and bulbar substitution urethroplasty. MATERIALS AND METHODS: We performed a retrospective descriptive analysis of patients who underwent substitution urethroplasty between July 1994 and September 2007. Inclusion criteria included 1-stage anterior urethroplasty using penile skin or oral mucosa with a minimum of 6 years followup. Patients with posterior urethral stricture, failed hypospadias or incomplete clinical records were excluded from analysis. The primary study outcome was postoperative failure-free survival and the secondary outcome was to identify significant predictors of treatment failure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done as well as Kaplan-Meier analysis, and univariable and multivariable Cox regression analysis. RESULTS: A total of 359 patients were included in study. Median followup was 118 months. Of the procedures 265 (73.8%) were successful and 94 (26.2%) failed, including 91 (96.8%) within the first 5 years. Substitute tissue type (oral mucosa vs skin) was the only significant predictor on univariable analysis (HR 1.86, p = 0.005). This result was confirmed by multivariable analysis adjusting for age at surgery, stricture length and etiology, urethroplasty type and previous treatments (HR 2.26, p = 0.001). CONCLUSIONS: Deterioration after anterior 1-stage substitution urethroplasty seems to develop within the first 5 years. Oral mucosa showed greater failure-free survival than penile skin and 1-stage penile urethroplasty showed the same success rate as bulbar urethroplasty.
PURPOSE: We investigated deterioration of the success rate of penile and bulbar substitution urethroplasty. MATERIALS AND METHODS: We performed a retrospective descriptive analysis of patients who underwent substitution urethroplasty between July 1994 and September 2007. Inclusion criteria included 1-stage anterior urethroplasty using penile skin or oral mucosa with a minimum of 6 years followup. Patients with posterior urethral stricture, failed hypospadias or incomplete clinical records were excluded from analysis. The primary study outcome was postoperative failure-free survival and the secondary outcome was to identify significant predictors of treatment failure. The clinical outcome was considered a failure when any postoperative instrumentation was needed. Descriptive statistical analysis was done as well as Kaplan-Meier analysis, and univariable and multivariable Cox regression analysis. RESULTS: A total of 359 patients were included in study. Median followup was 118 months. Of the procedures 265 (73.8%) were successful and 94 (26.2%) failed, including 91 (96.8%) within the first 5 years. Substitute tissue type (oral mucosa vs skin) was the only significant predictor on univariable analysis (HR 1.86, p = 0.005). This result was confirmed by multivariable analysis adjusting for age at surgery, stricture length and etiology, urethroplasty type and previous treatments (HR 2.26, p = 0.001). CONCLUSIONS: Deterioration after anterior 1-stage substitution urethroplasty seems to develop within the first 5 years. Oral mucosa showed greater failure-free survival than penile skin and 1-stage penile urethroplasty showed the same success rate as bulbar urethroplasty.
Authors: Ramiro J Madden-Fuentes; Michael J Belsante; Michael A Granieri; Andrew C Peterson Journal: World J Urol Date: 2019-03-01 Impact factor: 4.226
Authors: Keith F Rourke; Blayne Welk; Ron Kodama; Greg Bailly; Tim Davies; Nancy Santesso; Philippe D Violette Journal: Can Urol Assoc J Date: 2020-10 Impact factor: 2.052