A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis

Connor G. Policastro, Jay Simhan, Francisco E. Martins, Nicolaas Lumen, Krishnan Venkatesan, Javier C. Angulo, Shubham Gupta, Paul Rusilko, Erick Alejandro Ramírez Pérez, Kirk Redger, Brian J. Flynn, Michael Hughes, Stephen Blakely, Dmitriy Nikolavsky

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Purpose: To critically evaluate a multi-institutional patient cohort undergoing Dorsal-Onlay Buccal Mucosal Graft Urethroplasty (D-BMGU) for recurrent post-radiation posterior urethral stenosis. Methods: Retrospective multi-institutional review of patients with posterior urethral stenosis from 10 institutions between 2010–2019 was performed. Patients with at least 1-year follow-up were assessed. Patient demographics, stenosis characteristics, peri-operative outcomes, and post-operative clinical and patient-reported outcomes were analyzed. The primary outcomes were stenosis recurrence and de-novo stress urinary incontinence (SUI). Secondary outcomes were changes in voiding, sexual function, and patient-reported satisfaction. Results: Seventy-nine men with post-radiation urethral stenosis treated with D-BMGU met inclusion criteria. Median age and stenosis length were 72 years, (IQR 66–75), and 3.0 cm (IQR 2.5–4 cm), respectively. Radiation modalities included: 36 (45.6%) external beam radiotherapy (EBRT), 13 (16.5%) brachytherapy (BT), 10 (12.7%) combination EBRT/BT, and 20 (25.3%) EBRT/radical prostatectomy. At a median follow-up of 21 months (IQR 13–40), 14 patients (17.7%) had stenosis recurrence. Among 37 preoperatively-continent patients, 3 men (8.1%) developed de-novo SUI following dorsal onlay urethroplasty. Of 29 patients with preoperative SUI all but one remained incontinent post-operatively (96.6%). Following repair, patients experienced significant improvement in PVR (92.5 to 26 cc, p = 0.001) and Uroflow (4.6 to 15.9 cc/s, p = 0.001), and high overall satisfaction, with 91.9% reporting a GRA of + 2 or better). Conclusion: Dorsal onlay buccal mucosa graft urethroplasty is a safe and feasible technique in patients with post-radiation posterior urethral stenosis. This non-transecting approach may confer low rates of de-novo SUI. Further research is needed to compare this technique with excisional urethroplasty.

Original languageEnglish
Pages (from-to)2669-2675
Number of pages7
JournalWorld Journal of Urology
Volume39
Issue number7
DOIs
StatePublished - Jul 2021

Keywords

  • Aged
  • Humans
  • Male
  • Mouth Mucosa/transplantation
  • Radiation Injuries/surgery
  • Recurrence
  • Retrospective Studies
  • Urethra/surgery
  • Urethral Stricture/etiology
  • Urologic Surgical Procedures, Male/methods

Fingerprint

Dive into the research topics of 'A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis'. Together they form a unique fingerprint.

Cite this