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Staged urethroplasty for recurrent complex urethral strictures

Gvasalia, B1; Kochetov, A2; Vinogradov, I3; Gablia, M1; Epifanova, M4; Chaliy, M4

1: RUDN, Russia; 2: 3-d Central Military Hospital, Russia; 3: RUDN,Russia; 4: Sechenov University

Introduction & Objectives: The severest groups of patients are young men with recurrent urethral structures after 2 and more unsuccessful reconstructions. Some of them have suicide thoughts because of dramatic decline in quality of life. To evaluate outcomes of staged urethroplasty for recurrent complex urethral structures.

Material & Methods: 38 patients aged 43.1±5.8 with recurrent complex urethral strictures underwent staged urethral reconstruction. All patients 1-5 years before have undergone at least 2 unsuccessful urethroplasties, 24 (63%) of them – more than 4 operations. In 79% cases we used buccal-mucosa-graft for the first stage of reconstruction, or mesh-graft - in 21% cases. The second stage was done at least six months after the first stage. The tunica vaginalis vascularized graft was used as a barrier in all cases during tubularization stage of reconstruction. Study end points included: the success rate, erectile function and patient satisfaction postoperatively. Success was defined as stricture-free survival.

Results: The mean follow-up was 37 months (range 6 to 58). Etiology of stricture in 15.8% cases was lichen sclerosis, in 7.9% cases - traumatic injury, in 10.5% cases - infection, in 34.2% patients - failed surgery for hypospadias, in 18.4% instrumentation and in other cases etiology was unknown (13.1%). The mean stricture length was 7,2cm. Overall satisfaction with surgery was high (79%) and an improvement in QoL was reported by 82 %. The overall complications rate in 38 patients was 15.8% (6), including fistula in 2, stricture recurrence in 4. Patients with stricture recurrence have insisted on lifelong perineostomy. Fistulas were also successfully closed.

 Mean pre- and post-operative Qmax, IIEF-5, QoL scores

Before

surgery (n=38)

3 months

 (n=38)

12 months

(n=35)

36 months

(n=30)

Qmax

4,11±3,51

21,34±8,24*

19,64±8,71

18,16±8,44

QoL

5,12±2,11

1,92±1,69*

1,63±1,49

1,66±1,52

IIEF

13,89±7,42

14,36±6,39

18,78±6,04**

18,37±6,53

*Comparison of scores before surgery and 3 months post-op (р<0.05)
**Comparison of post-op scores at 3 months and 12 months (р<0.05)

Conclusion: Staged urethroplasty is a method of choice in patients with severe recurrent urethral strictures. It should be performed strictly in specialized centers by experienced urethral surgeons.

 

Disclosure:

Work supported by industry: no.

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