Long-term outcomes for 2-stage urethroplasty: an analysis of risk factors for urethral stricture recurrence

Abstract

Purpose: To report long-term results and patient reported outcomes of staged anterior urethroplasties, and isolate risk factors for recurrence.

Methods: We reviewed urethroplasty database for all patients who underwent staged urethroplasty from 2000 to 2017. Follow-up included a cystoscopy 4 months after their 2nd stage to assess early success, and then annual follow-up thereafter with post-void residual and symptom assessment. Stricture characteristics, etiology and graft type were analyzed with regards to success.

Results: Forty-nine patients were eligible for inclusion. The median stricture length was 7 cm (3-17 cm). The early success rate demonstrated by cystoscopy at 4 months was 100%. Long-term success was 96.4% in buccal graft (BMG) only patients; however, long-term success fell considerably to 53% in patients requiring any use split thickness skin graft (STSG) in the first stage. Median follow up time was 57 months (6-240 months). On analysis, age, increased stricture length and especially the use of STSG all appeared to be associated with late recurrence. The recurrence group had longer stricture length and were more likely to be panurethral. All recurrences occurred after the initial 4-month cystoscopy with a median time to recurrence of 78 months.

Conclusion: Staged repairs that are amenable to BMG-only repairs have high long-term success rates. Increasing stricture length and the addition of split-thickness skin graft were associated with lower success rate in staged urethral reconstruction. Patients requiring staged repairs often experience recurrence in a very delayed fashion reinforcing the need for close, long-term follow up.

Keywords: Buccal graft; Split thickness skin graft; Staged urethroplasty; Urethral stricture; Urethroplasty.

Fig. 1

a Patient with a long penile urethral stricture and history of hypospadias. b The ventral urethrotomy has been made and BMG fixated to either side of the urethral plate. c Demonstration of 3 cm width to the healed urethral plate to allow for a 30Fr caliber lumen. D&E) Closure is accomplished in multiple layers