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Angulo JC, Kulkarni S, Pankaj J, Nikolavsky D, Suarez P, Belinky J, Virasoro R, DeLong J, Martins FE, Lumen N, Giudice C, Suárez OA, Menéndez N, Capiel L, López-Alvarado D, Ramirez EA, Venkatesan K, Husainat MM, Esquinas C, Arance I, Gómez R, Santucci R. Urethroplasty After Urethral Urolume Stent: An International Multicenter Experience. Urology 2018; 118:213-219. [PMID: 29751026 DOI: 10.1016/j.urology.2018.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/22/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the outcomes and factors affecting success of urethroplasty in patients with stricture recurrence after Urolume urethral stent. MATERIAL AND METHODS This is a retrospective international multicenter study on patients treated with urethral reconstruction after Urolume stent. Stricture and stent length, time between urethral stent insertion and urethroplasty, age, mode of stent retrieval, type of urethroplasty, complications and baseline, and posturethroplasty voiding parameters were analyzed. Successful outcome was defined as standard voiding, without need of any postoperative adjunctive procedure. RESULTS Sixty-three patients were included. Stent was removed at urethroplasty in 61 patients. Reconstruction technique was excision and primary anastomosis in 14 (22.2%), dorsal onlay buccal mucosa graft (BMG) in 9 (14.3%), ventral onlay BMG in 6 (9.5%), dorsolateral onlay BMG in 9 (14.3%), ventral onlay plus dorsal inlay BMG in 3 (4.8%), augmented anastomosis in 5 (7.9%), pedicled flap urethroplasty in 6 (9.5%), 2-stage procedure in 4 (6.4%), and perineal urethrostomy in 7(11.1%). Success rate was 81% at a mean 59.7 ± 63.4 months. Dilatation or internal urethrotomy was performed in 10 (15.9%) and redo-urethroplasty in 5 (7.9%). Total International Prostate Symptom Score, quality of life, urine maximum flow, and postvoid residual significantly improved (P <.0001). Complications occurred in 8 (12.7%), all Clavien-Dindo ≤2. Disease-free survival rate after reconstruction was 88.1%, 79.5%, and 76.7% at 1, 3, and 5 years, respectively. Explant of individual strands followed by onlay BMG is the most common approach and was significantly advantageous over the other techniques (P = .018). CONCLUSION Urethroplasty in patients with Urolume urethral stents is a viable option of reconstruction with a high success rate and very acceptable complication rate. Numerous techniques are viable; however, urethral preservation, tine-by-tine stent extraction, and use of BMG augmentation produced significantly better outcomes.
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Affiliation(s)
- Javier C Angulo
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain.
| | | | - Joshi Pankaj
- Kulkarni Center for Reconstructive Urology, Pune, India
| | | | - Pedro Suarez
- Sección Cirugía Reconstructiva Uretral, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Javier Belinky
- Hospital General de Agudos Carlos G. Durand, Buenos Aires, Argentina
| | - Ramón Virasoro
- Eastern Virginia Medical School, Norfolk, VA; Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | | | | | - Carlos Giudice
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Oscar A Suárez
- Hospital San José Tecnológico de Monterrey, Universidad de Monterrey, Nuevo León, Mexico
| | | | - Leandro Capiel
- Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | | | | | - Maha M Husainat
- Detroit Medical Center, Detroit Receiving Hospital, Detroit, MI
| | - Cristina Esquinas
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain
| | - Ignacio Arance
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Hospital Universitario de Getafe, Madrid, Spain
| | - Reynaldo Gómez
- Hospital del Trabajador, Universidad Andrés Bello, Santiago de Chile, Chile
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Buckley JC, Zinman LN. Removal of Endoprosthesis with Urethral Preservation and Simultaneous Urethral Reconstruction. J Urol 2012; 188:856-60. [DOI: 10.1016/j.juro.2012.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Jill C. Buckley
- Trauma and Reconstruction, Department of Urology, Lahey Clinic Medical Center, Tufts School of Medicine, Burlington, Massachusetts
| | - Leonard N. Zinman
- Trauma and Reconstruction, Department of Urology, Lahey Clinic Medical Center, Tufts School of Medicine, Burlington, Massachusetts
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