Uretroplastia aumentada: fallo?
J Urol. 2020 Jun 5:101097
Augmented Anastomotic Urethroplasty is Independently Associated with Failure after Reconstruction for Long Bulbar Urethral Strictures.
Redmond EJ1, Hoare DT1, Rourke KF1.
1. Division of Urology, University of Alberta, Edmonton, Alberta.
Controversy exists regarding the optimal urethroplasty technique, particularly for long bulbar urethral strictures requiring buccal mucosal graft (BMG). The aim of our study was to assess the relative outcomes of augmented anastomotic urethroplasty (AAU) versus dorsal onlay (DO) in the setting of bulbar urethroplasty using a dorsal BMG.
A retrospective review was performed on all patients who underwent bulbar urethroplasty with dorsal BMG between October 2003 and March 2019. In ∼2011, institutional technique shifted from routinely performing a transecting AAU to a non-transecting DO. Anastomotic urethroplasty without BMG, ventral onlay, staged, flap and circumferential reconstructions were excluded. The primary outcome was stricture recurrence defined as <16Fr on cystoscopy. Secondary outcomes included 90-day complications and de novo erectile dysfunction at 6 months.
Of the 836 patients who underwent bulbar urethroplasty during the study period, 507 met inclusion criteria. Of these, 221 patients received an AAU while 286 underwent DO urethroplasty. Mean patient age and stricture length was 45.4±14.8 years and 4.4±1.5cm, respectively. Overall success rate was 93.9% (476/507) with a mean follow-up of 78.9 months. On multivariate analysis, AAU (H.R. 4.8,p=0.002), increasing stricture length (H.R.1.2,p=0.002) and iatrogenic strictures (H.R.3.2,p=0.03) were independently associated with stricture recurrence, while comorbidity (p=0.06), prior endoscopic treatment (p=0.41), prior urethroplasty (p=0.89) and other etiologies were not. There was no difference between cohorts with respect to Clavien ≥2 complications (3.6% vs 4.2%; p=0.74) or de novo erectile dysfunction (5.9% vs 5.6%; p=0.89).
AAU is independently associated with stricture recurrence when compared to a pure DO technique.Uretrplastia