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

doi:10.1007/s00345-020-03446-y

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

SUNY Upstate Medical University
University of Lisbon
Ghent University
Georgetown University
Washington Hospital Center
Universidad Europea
Case Western Reserve University
University of Pittsburgh
Hospital Angeles Mocel
University of Colorado Anschutz Medical Campus

Research output: Contribution to journal › Article › peer-review

26 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 language	English
Pages (from-to)	2669-2675
Number of pages	7
Journal	World Journal of Urology
Volume	39
Issue number	7
DOIs	https://doi.org/10.1007/s00345-020-03446-y
State	Published - 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

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10.1007/s00345-020-03446-y

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Policastro, C. G., Simhan, J., Martins, F. E., Lumen, N., Venkatesan, K., Angulo, J. C., Gupta, S., Rusilko, P., Ramírez Pérez, E. A., Redger, K., Flynn, B. J., Hughes, M., Blakely, S., & Nikolavsky, D. (2021). A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis. World Journal of Urology, 39(7), 2669-2675. https://doi.org/10.1007/s00345-020-03446-y

@article{197bc58301ac4d3ba9322b4a64d09c08,

title = "A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis",

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.",

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

author = "Policastro, \{Connor G.\} and Jay Simhan and Martins, \{Francisco E.\} and Nicolaas Lumen and Krishnan Venkatesan and Angulo, \{Javier C.\} and Shubham Gupta and Paul Rusilko and \{Ram{\'i}rez P{\'e}rez\}, \{Erick Alejandro\} and Kirk Redger and Flynn, \{Brian J.\} and Michael Hughes and Stephen Blakely and Dmitriy Nikolavsky",

note = "Publisher Copyright: {\textcopyright} 2020, Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2021",

month = jul,

doi = "10.1007/s00345-020-03446-y",

language = "English",

volume = "39",

pages = "2669--2675",

journal = "World Journal of Urology",

issn = "0724-4983",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "7",

}

Policastro, CG, Simhan, J, Martins, FE, Lumen, N, Venkatesan, K, Angulo, JC, Gupta, S, Rusilko, P, Ramírez Pérez, EA, Redger, K, Flynn, BJ, Hughes, M, Blakely, S & Nikolavsky, D 2021, 'A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis', World Journal of Urology, vol. 39, no. 7, pp. 2669-2675. https://doi.org/10.1007/s00345-020-03446-y

TY - JOUR

T1 - A multi-institutional critical assessment of dorsal onlay urethroplasty for post-radiation urethral stenosis

AU - Policastro, Connor G.

AU - Simhan, Jay

AU - Martins, Francisco E.

AU - Lumen, Nicolaas

AU - Venkatesan, Krishnan

AU - Angulo, Javier C.

AU - Gupta, Shubham

AU - Rusilko, Paul

AU - Ramírez Pérez, Erick Alejandro

AU - Redger, Kirk

AU - Flynn, Brian J.

AU - Hughes, Michael

AU - Blakely, Stephen

AU - Nikolavsky, Dmitriy

PY - 2021/7

Y1 - 2021/7

N2 - 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.

AB - 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.

KW - Aged

KW - Humans

KW - Male

KW - Mouth Mucosa/transplantation

KW - Radiation Injuries/surgery

KW - Recurrence

KW - Retrospective Studies

KW - Urethra/surgery

KW - Urethral Stricture/etiology

KW - Urologic Surgical Procedures, Male/methods

UR - https://www.scopus.com/pages/publications/85091042112

U2 - 10.1007/s00345-020-03446-y

DO - 10.1007/s00345-020-03446-y

M3 - Article

C2 - 32944804

AN - SCOPUS:85091042112

SN - 0724-4983

VL - 39

SP - 2669

EP - 2675

JO - World Journal of Urology

JF - World Journal of Urology

IS - 7

ER -

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

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Keywords

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