Satish K Goonesinghe1, Christopher J Hillary2, Timothy R Nicholson3, Nadir I Osman2, Christopher R Chapple4. 1. Department of Urology, Karapitiya Teaching Hospital, Galle, Sri Lanka. 2. Department of Urology, Royal Hallamshire Hospital, Sheffield, UK. 3. Western NSW Local Health District, Orange, New South Wales, Australia. 4. Department of Urology, Royal Hallamshire Hospital, Sheffield, UK. Electronic address: c.r.chapple@sheffield.ac.uk.
Abstract
BACKGROUND: Urethral strictures can be difficult to diagnose at an early stage because the urinary flow rate does not diminish until the urethral calibre is ≤3mm. In the past, posturethral surgery follow-up has relied upon flow rates and contrast imaging. OBJECTIVE: To evaluate the role of flexible urethroscopy in the follow-up of patients undergoing urethroplasty. DESIGN, SETTING, AND PARTICIPANTS: Prospective flexible urethroscopy follow-up of 144 male patients who underwent urethroplasty by a single surgeon over a 10-yr period at a tertiary referral centre. INTERVENTION: Flexible urethroscopy at 3, 6, and 12 mo postoperatively, and annually thereafter. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Type of recurrence, based on urethroscopy findings, and further interventions were measured. Actuarial analysis was performed using Kaplan-Meier curves and a log-rank test. RESULTS AND LIMITATIONS: All 144 patients underwent flexible urethroscopy follow-up over a median postoperative follow-up of 22 mo (range: 1-96 mo). No further intervention was required for 117 patients (81.25%); 27 (18.75%) developed recurrences that required further treatment. Recurrences included diaphragms (13 patients) or significant restenosis (14 patients). Diaphragms were treated by urethrotomy, gentle dilatation, or a short course of intermittent self-dilatation. Restenosis required repeated simple procedures or surgical revision. Most recurrences (26 of 27, 96%) were detected within the first year. Urinary peak flow-rate data were available for 11 of 27 of these recurrences; 7 patients had flow rates >15ml/s. Anastomotic procedures had greater success than augmentation urethroplasty (p=0.0136); there was no significant difference in outcomes between redo and non-redo surgery (p=0.2093) CONCLUSIONS: Endoscopic follow-up of patients after urethroplasty enables earlier identification and treatment of recurrences compared to the use of urinary flow rates alone. It also enables the identification of two different morphologic recurrence patterns that require different types of intervention. PATIENT SUMMARY: Endoscopy detects most stricture recurrences within 1 yr after urethroplasty and is more sensitive than using urinary flow rates alone.
BACKGROUND: Urethral strictures can be difficult to diagnose at an early stage because the urinary flow rate does not diminish until the urethral calibre is ≤3mm. In the past, posturethral surgery follow-up has relied upon flow rates and contrast imaging. OBJECTIVE: To evaluate the role of flexible urethroscopy in the follow-up of patients undergoing urethroplasty. DESIGN, SETTING, AND PARTICIPANTS: Prospective flexible urethroscopy follow-up of 144 male patients who underwent urethroplasty by a single surgeon over a 10-yr period at a tertiary referral centre. INTERVENTION: Flexible urethroscopy at 3, 6, and 12 mo postoperatively, and annually thereafter. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Type of recurrence, based on urethroscopy findings, and further interventions were measured. Actuarial analysis was performed using Kaplan-Meier curves and a log-rank test. RESULTS AND LIMITATIONS: All 144 patients underwent flexible urethroscopy follow-up over a median postoperative follow-up of 22 mo (range: 1-96 mo). No further intervention was required for 117 patients (81.25%); 27 (18.75%) developed recurrences that required further treatment. Recurrences included diaphragms (13 patients) or significant restenosis (14 patients). Diaphragms were treated by urethrotomy, gentle dilatation, or a short course of intermittent self-dilatation. Restenosis required repeated simple procedures or surgical revision. Most recurrences (26 of 27, 96%) were detected within the first year. Urinary peak flow-rate data were available for 11 of 27 of these recurrences; 7 patients had flow rates >15ml/s. Anastomotic procedures had greater success than augmentation urethroplasty (p=0.0136); there was no significant difference in outcomes between redo and non-redo surgery (p=0.2093) CONCLUSIONS: Endoscopic follow-up of patients after urethroplasty enables earlier identification and treatment of recurrences compared to the use of urinary flow rates alone. It also enables the identification of two different morphologic recurrence patterns that require different types of intervention. PATIENT SUMMARY: Endoscopy detects most stricture recurrences within 1 yr after urethroplasty and is more sensitive than using urinary flow rates alone.
Authors: David B Bayne; Thomas W Gaither; Mohannad A Awad; Gregory P Murphy; E Charles Osterberg; Benjamin N Breyer Journal: Transl Androl Urol Date: 2017-04