Abstract
Introduction: This study was carried out to identify the predictors of urethral stricture recurrence after dorsal onlay buccal mucosal graft (BMG) urethroplasty. Materials and Methods: The medical records of patients with anterior urethral stricture who underwent dorsal onlay BMG urethroplasty at a single tertiary medical center during the period from March 2010 to January 2018 were reviewed. Only patients with ≥2-year follow-up were included. Data regarding patient demographics, clinical characteristics, stricture characteristics, postoperative course, and adverse events were recorded. Kaplan-Meier analysis was used to assess the recurrence-free survival and likelihood of stricture recurrence. Cox regression analysis was used to identify potential independent predictors of stricture recurrence. Results: This study included 266 patients with a mean age of 37.71 years and a mean follow-up period of 49.77 months. From the overall study cohort, 34 (12.8%) reported stricture recurrence and 232 (87.2%) were not. The mean recurrence-free time was 79.93 months and mean time to recurrence was 21.59 months. On multivariate analysis, obesity (hazard ratio (HR): 6.02; 95% conference interval (CI): 1.91, 19.03: p = 0.002), inflammatory aetiology (HR: 9.13; 95% CI: 3.50, 23.81; p < 0.001), prior urethroplasty (HR: 8.81; 95% CI: 3.26, 23.86; p < 0.001), penile stricture location (HR: 3.09; 95% CI: 1.10, 8.71; p = 0.033), and stricture length >4.5 cm (HR: 6.83; 95% CI: 1.69, 27.62; p = 0.007) were the significant independent predictors of stricture recurrence. Conclusions: Dorsal onlay BMG urethroplasty has a reasonable recurrence-free rate with acceptable postoperative complications. Obesity, inflammatory etiology, prior urethroplasty, penile stricture location, and longer stricture were the factors associated with urethral stricture recurrence.
References
1.
Santucci
RA
, Joyce
GF
, Wise
M
. Male urethral stricture disease
. J Urol
. 2007
;177
(5
):1667
–74
. .2.
Rourke
K
, Hickle
J
. The clinical spectrum of the presenting signs and symptoms of anterior urethral stricture: detailed analysis of a single institutional cohort
. Urology
. 2012
;79
(5
):1163
–7
. .3.
Rourke
KF
, Jordan
GH
. Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture
. J Urol
. 2005
;173
(4
):1206
–10
. .4.
Burks
FN
, Santucci
RA
. Complicated urethroplasty: a guide for surgeons
. Nat Rev Urol
. 2010
;7
(9
):521
. .5.
Barbagli
G
, Selli
C
, Tosto
A
, Palminteri
E
. Dorsal free graft urethroplasty
. J Urol
. 1996
;155
(1
):123
–6
. .6.
Chapple
C
, Andrich
D
, Atala
A
, Barbagli
G
, Cavalcanti
A
, Kulkarni
S
, et al. SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty
. Urology
. 2014
;83
(3 Suppl
):S31
–47
. .7.
Shalkamy
OA
, Abdelrahim
AF
, Elmikkawy
SA
, Mourad
MM
, Eleweedy
SM
. Long-term outcomes of single stage dorsal onlay buccal mucosa urethroplasty for different anterior urethral strictures: a prospective study
. Urol Nephrol Open Access J
. 2017
;5
(5
):00188
. .8.
Mangera
A
, Patterson
JM
, Chapple
CR
. A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures
. Eur Urol
. 2011
;59
(5
):797
–814
. .9.
Soave
A
, Steurer
S
, Dahlem
R
, Rink
M
, Reiss
P
, Fisch
M
, et al. Histopathological characteristics of buccal mucosa transplants in humans after engraftment to the urethra: a prospective study
. J Urol
. 2014
;192
(6
):1725
–9
. .10.
Soave
A
, Kluth
L
, Dahlem
R
, Rohwer
A
, Rink
M
, Reiss
P
, et al. Outcome of buccal mucosa graft urethroplasty: a detailed analysis of success, morbidity and quality of life in a contemporary patient cohort at a referral center
. BMC Urol
. 2019
;19
(1
):18
. .11.
Ahyai
SA
, Schmid
M
, Kuhl
M
, Kluth
LA
, Soave
A
, Riechardt
S
, et al. Outcomes of ventral onlay buccal mucosa graft urethroplasty in patients after radiotherapy
. J Urol
. 2015
;194
(2
):441
–6
. .12.
Marshall
SD
, Raup
VT
, Brandes
SB
. Dorsal inlay buccal mucosal graft (Asopa) urethroplasty for anterior urethral stricture
. Transl Androl Urol
. 2015
;4
(1
):10
. .13.
Pfalzgraf
D
, Kluth
L
, Isbarn
H
, Reiss
P
, Riechardt
S
, Fisch
M
, et al. The Barbagli technique: 3-year experience with a modified approach
. BJU Int
. 2013
;111
(3b
):E132
–6
.14.
Chapman
D
, Kinnaird
A
, Rourke
K
. Independent predictors of stricture recurrence following urethroplasty for isolated bulbar urethral strictures
. J Urol
. 2017
;198
(5
):1107
–12
. .15.
Barbagli
G
, Kulkarni
SB
, Fossati
N
, Larcher
A
, Sansalone
S
, Guazzoni
G
, et al. Long-term followup and deterioration rate of anterior substitution urethroplasty
. J Urol
. 2014
;192
(3
):808
–13
. .16.
Barbagli
G
, Selli
C
, Di Cello
V
, Mottola
A
. A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures
. Br J Urol
. 1996
;78
(6
):929
–32
. .17.
Kinnaird
AS
, Levine
MA
, Ambati
D
, Zorn
JD
, Rourke
KF
. Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: a multivariate analysis of 604 urethroplasties
. Can Urol Assoc J
. 2014
;8
(5–6
):E296
. .18.
Han
JS
, Liu
J
, Hofer
MD
, Fuchs
A
, Chi
A
, Stein
D
, et al. Risk of urethral stricture recurrence increases over time after urethroplasty
. Int J Urol
. 2015
;22
(7
):695
–9
. .19.
Breyer
BN
, McAninch
JW
, Whitson
JM
, Eisenberg
ML
, Mehdizadeh
JF
, Myers
JB
, et al. Multivariate analysis of risk factors for long-term urethroplasty outcome
. J Urol
. 2010
;183
(2
):613
–7
. .20.
Liu
JS
, Dong
C
, Gonzalez
CM
. Risk factors and timing of early stricture recurrence after urethroplasty
. Urology
. 2016
;95
:202
–7
. .21.
Spilotros
M
, Sihra
N
, Malde
S
, Pakzad
MH
, Hamid
R
, Ockrim
JL
, et al. Buccal mucosal graft urethroplasty in men: risk factors for recurrence and complications: a third referral centre experience in anterior urethroplasty using buccal mucosal graft
. Transl Androl Urol
. 2017
;6
(3
):510
.22.
Santucci
RA
, McAninch
JW
, Mario
LA
, Rajpurkar
A
, Chopra
AK
, Miller
KS
, et al. Urethroplasty in patients older than 65 years: indications, results, outcomes and suggested treatment modifications
. J Urol
. 2004
;172
(1
):201
–3
. .23.
Barbagli
G
, De Angelis
M
, Romano
G
, Lazzeri
M
. Long-term follow-up of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience
. J Urol
. 2007
;178
(6
):2470
–3
.24.
Kulkarni
S
, Barbagli
G
, Sansalone
S
, Lazzeri
M
. One-sided anterior urethroplasty: a new dorsal onlay graft technique
. BJU Int
. 2009
;104
(8
):1150
–5
.25.
Privratsky
JR
, Almassi
N
, Guralnick
ML
, Anderson
BJ
, O’Connor
RC
. Outcomes of grafted bulbar urethroplasty in men with class II or III obesity
. Urology
. 2011
;78
(6
):1420
–3
. .26.
Breyer
BN
, McAninch
JW
, Whitson
JM
, Eisenberg
ML
, Master
VA
, Voelzke
BB
, et al. Effect of obesity on urethroplasty outcome
. Urology
. 2009
;73
(6
):1352
–5
. .27.
Figler
BD
, Malaeb
BS
, Dy
GW
, Voelzke
BB
, Wessells
H
. Impact of graft position on failure of single-stage bulbar urethroplasties with buccal mucosa graft
. Urology
. 2013
;82
(5
):1166
–70
. .28.
Sinha
RJ
, Singh
V
, Sankhwar
SN
. Does tobacco consumption influence outcome of oral mucosa graft urethroplasty?
Urol J
. 2010
;7
(1
):45
–50
.29.
Ekerhult
TO
, Lindqvist
K
, Peeker
R
, Grenabo
L
. Limited experience, high body mass index and previous urethral surgery are risk factors for failure in open urethroplasty due to penile strictures
. Scand J Urol
. 2015
;49
(5
):415
–8
. .30.
Rapp
DE
, Mills
JT
, Smith-Harrison
LI
, Smith
RP
, Costabile
RA
. Effect of body mass index on recurrence following urethroplasty
. Transl Androl Urol
. 2018
;7
(4
):673
. .31.
Rosenberg
CS
. Wound healing in the patient with diabetes mellitus
. Nurs Clin North Am
. 1990
;25
(1
):247
–61
.32.
Mills
E
, Eyawo
O
, Lockhart
I
, Kelly
S
, Wu
P
, Ebbert
JO
. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis
. Am J Med
. 2011
;124
(2
):144
–154.e8
. .33.
Kessler
TM
, Schreiter
F
, Kralidis
G
, Heitz
M
, Olianas
R
, Fisch
M
. Long-term results of surgery for urethral stricture: a statistical analysis
. J Urol
. 2003
;170
(3
):840
–4
. .34.
Barbagli
G
, Palminteri
E
, Lazzeri
M
, Guazzoni
G
, Turini
D
. Long-term outcome of urethroplasty after failed urethrotomy versus primary repair
. J Urol
. 2001
;165
(6 Pt 1
):1918
–9
. .35.
Wang
K
, Miao
X
, Wang
L
, Li
H
. Dorsal onlay versus ventral onlay urethroplasty for anterior urethral stricture: a meta-analysis
. Urol Int
. 2009
;83
(3
):342
–8
. .36.
Gimbernat
H
, Arance
I
, Redondo
C
, Meilán
E
, Ramón de Fata
F
, Angulo
JC
. Analysis of the factors involved in the failure of urethroplasty in men
. Actas Urol Esp
. 2014
;38
(2
):96
–102
. .© 2020 S. Karger AG, Basel
2020
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