J Urol. 2019 Jan 25. doi: 10.1097/JU.0000000000000027. [Epub ahead of print]
Urinary and sexual function after perineal urethrostomy for urethral stricture disease: An analysis from Trauma and Urologic Reconstructive Network of Surgeons (TURNS).
1. Division of Urology, Washington University, St. Louis, MO.
2. Department of Urology, University of California San Francisco, San Francisco, CA.
3. Department of Urology, University of Washington, Seattle, WA.
4. Division of Urology, University of Utah, Salt Lake City, UT.
5. Department of Urology, University of Iowa, Iowa City, IA.
6. Department of Urology, University of Minnesota, Minneapolis, MN.
7. Uropartners, Gurnee, IL.
8. Department of Urology, Lahey Hospital and Medical Center, Burlington, MA.
9. Department of Urology, UC San Diego Health System, San Diego, CA.
Perineal urethrostomy is a viable option for many complex urethral strictures; however, no comparison with anterior urethroplasty (AU) regarding patient reported outcome measures (PROMs) has been published. We sought to compare these groups using a large multi-institution database.
MATERIALS AND METHODS:
A retrospective study of AU in the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) database was performed. The AU cohort was defined by long strictures >6 cm. We compared demographic, clinical, urinary and sexual characteristics using validated PROMs between long stricture AU and perineal urethrostomy patients.
Of the 131 patients, 92 with long stricture AU and 39 patients with perineal urethrostomy who met inclusion criteria. Cumulative incidence of failure at 2 years was 30.2% (95% CI 18.3 – 47.3) for long stricture AU and 14.5% (95% CI 4.8 – 39.1) for perineal urethrostomy (p=0.09). Compared to baseline metrics, patients with long stricture AU and perineal urethrostomy had similar improvements in urinary function and stable sexual function after surgery.
Patients report improvement in urinary function after perineal urethrostomy with no deleterious effect on sexual function. These PROMs are comparable with long stricture AU. Perineal urethrostomy failure rates were similar to long stricture AU.