Multi-Institutional Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty in Patients with Postprostatectomy, Postradiation Anastomotic Stenosis

Joshua Sterling, Jay Simhan, Brian J. Flynn, Paul Rusilko, Wagner A. França, Erick A. Ramirez, Javier C. Angulo, Francisco E. Martins, Hiren V. Patel, Margaret Higgins, Daniel Swerdloff, Dmitriy Nikolavsky

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Purpose:The treatment of urethral stenosis after a combination of prostatectomy and radiation therapy for prostate cancer is understudied. We evaluate the clinical and patient-related outcomes after dorsal onlay buccal mucosal graft urethroplasty (D-BMGU) in men who underwent prostatectomy and radiation therapy.Materials and Methods:A multi-institutional, retrospective review of men with vesicourethral anastomotic stenosis or bulbomembranous urethral stricture disease after radical prostatectomy and radiation therapy from 8 institutions between 2013 to 2021 was performed. The primary outcomes were stenosis recurrence and development of de novo stress urinary incontinence. Secondary outcomes were surgical complications, changes in voiding, and patient-reported satisfaction.Results:Forty-five men were treated with D-BMGU for stenosis following prostatectomy and radiation. There was a total of 7 recurrences. Median follow-up in patients without recurrence was 21 months (IQR 12-24). There were no incidents of de novo incontinence, 28 patients were incontinent pre- and postoperatively, and of the 6 patients managed with suprapubic catheter preoperatively, 4 were continent after repair. Following repair, men had significant improvement in postvoid residual, uroflow, International Prostate Symptom Score, and International Prostate Symptom Score quality-of-life domain. Overall satisfaction was +2 or better in 86.6% of men on the Global Response Assessment.Conclusions:D-BMGU is a safe, feasible, and effective technique in patients with urethral stenosis after a combination of prostatectomy and radiation therapy. Although our findings suggest this technique may result in lower rates of de novo urinary incontinence compared to conventional urethral transection and excision techniques, head-to-head comparisons are needed.

Original languageEnglish
Pages (from-to)596-604
Number of pages9
JournalJournal of Urology
Volume211
Issue number4
DOIs
StatePublished - Apr 1 2024

Keywords

  • buccal mucosal urethroplasty
  • post-radiation strictures
  • reconstructive urology
  • salvage prostatectomy
  • vesicourethral anastomotic stenosis
  • Constriction, Pathologic/surgery
  • Urologic Surgical Procedures, Male/methods
  • Mouth Mucosa/transplantation
  • Humans
  • Male
  • Treatment Outcome
  • Prostatectomy/adverse effects
  • Urethra/surgery
  • Urinary Incontinence/surgery
  • Retrospective Studies
  • Urethral Stricture/etiology

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