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MP03-12 MULTI-INSTITUTIONAL FEASIBILITY OF DORSAL ONLAY URETHROPLASTY FOR MEMBRANOUS URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE PROCEDURES: OPERATIVE RESULTS AND MULTIVARIATE ANALYSIS

2021; Lippincott Williams & Wilkins; Volume: 206; Issue: Supplement 3 Linguagem: Inglês

10.1097/ju.0000000000001964.12

1527-3792

Connor Policastro, Francisco E. Martins, Keith Rourke, Erick A. Ramírez, Jaime Gago, Jay Simhan, Eric Li, Paul Rusilko, K. Venkatesan, Jonathan N. Warner, Dmitriy Nikolavsky, Javier Angulo,

Hernia repair and management

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP03)1 Sep 2021MP03-12 MULTI-INSTITUTIONAL FEASIBILITY OF DORSAL ONLAY URETHROPLASTY FOR MEMBRANOUS URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE PROCEDURES: OPERATIVE RESULTS AND MULTIVARIATE ANALYSIS Connor Policastro, Francisco Martins, Keith Rourke, Erick Ramírez, Jaime Gago, Jay Simhan, Eric Li, Paul Rusilko, Krishnan Venkatesan, Jonathan Warner, Dmitriy Nikolavsky, and Javier Angulo Connor PolicastroConnor Policastro More articles by this author , Francisco MartinsFrancisco Martins More articles by this author , Keith RourkeKeith Rourke More articles by this author , Erick RamírezErick Ramírez More articles by this author , Jaime GagoJaime Gago More articles by this author , Jay SimhanJay Simhan More articles by this author , Eric LiEric Li More articles by this author , Paul RusilkoPaul Rusilko More articles by this author , Krishnan VenkatesanKrishnan Venkatesan More articles by this author , Jonathan WarnerJonathan Warner More articles by this author , Dmitriy NikolavskyDmitriy Nikolavsky More articles by this author , and Javier AnguloJavier Angulo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001964.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reconstruction of membranous urethral stenosis in patients with previous transurethral resection of the prostate (TURP) or other endoscopic prostate ablative procedures is a surgical challenge that is poorly described. Here we evaluate multi-institutional results of Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (DBMGU) for urethral stricture in these patients. METHODS: Multi-institutional review of DBMGU in patients with membranous or bulbomembranous urethral stenosis from 2002 to 2020 and a minimum of 6-months follow-up was conducted. The primary objective was evaluation of urethral patency and stenosis recurrence with identification of risk factors using stepwise logistic regression (p=0.1 entry and p=0.05 stay criteria) and assessment of de-novo stress urinary incontinence (SUI). Secondary objectives included an evaluation of changes in voiding, sexual function and patient satisfaction. RESULTS: 107 men with post-TURP urethral stenosis received DBMGU. Mean age, stenosis length and BMI were 69±9.5 years, 3.5±1.8 cm and 27.7±5, respectively. Prior endoscopic procedures included: 47 (44%) monopolar TURP, 33 (30.8%) bipolar TURP, 16 (15%) Greenlight laser, 9 (8.4%) holmium laser enucleation and 2 (1.9%) transurethral bladder neck incision. Radiotherapy was performed in 10 (9.3%). At a mean of 59.3±45.1 months follow-up (range 6-148), stenosis recurred in 10 patients (9.35%). Univariate analysis revealed diabetes, smoking, monopolar TURP, associated radiation, prior dilatation, prior DVIU, stricture length and postoperative complications within 90 days were included in the regression model for recurrence. Multivariate analysis confirmed postoperative complications (OR 12.5; p=.009), associated radiation (OR 8.3; p=.016) and ≥2 dilatations before urethroplasty (OR 8.3; p=.032) as independent predictors of recurrence. Only 1 patient (0.9%) developed de-novo SUI following DBMGU. Patients had improvement in Qmax (6.2 to 16.8cc/s; p<.001), PVR (128 to 60cc; p<.001), SHIM (11.5 to 11.7; p=.028), IPSS (20 to 7.7; p<.001) and QoL (4.4 to 1.7; p<.001). 87 cases (81.3%) reported GRA of +2 or better. CONCLUSIONS: DBMGU is effective in treating post-TURP bulbomembranous stenosis. This non-transecting approach confers a very low risk of de-novo SUI, preserves erectile function and improves voiding function. Further work is needed to compare this technique with other approaches in this challenging setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e25-e26 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Connor Policastro More articles by this author Francisco Martins More articles by this author Keith Rourke More articles by this author Erick Ramírez More articles by this author Jaime Gago More articles by this author Jay Simhan More articles by this author Eric Li More articles by this author Paul Rusilko More articles by this author Krishnan Venkatesan More articles by this author Jonathan Warner More articles by this author Dmitriy Nikolavsky More articles by this author Javier Angulo More articles by this author Expand All Advertisement Loading ...