Citation
Cotter KJ, Hahn AE, Voelzke BB, Myers JB, Smith TG 3rd, Elliott SP, Alsikafi NF, Breyer BN, Vanni AJ, Buckley JC, Zhao LC, Broghammer JA, Erickson BA; Trauma and Urologic Reconstruction Network of Surgeons (TURNS). Trends in Urethral Stricture Disease Etiology and Urethroplasty Technique from a Multi-Institutional Surgical Outcomes Research Group. Urology. 2019 Aug;130:167-174.
Abstract
To analyze contemporary urethroplasty trends and urethral stricture etiologies over a 7-year study period among urologists from a large multi-institutional surgical outcomes group. Review of a multi-institutional, prospectively maintained urethroplasty database was performed on 2098 anterior urethroplasties done between 2010 and 2017 by 10 surgeons. Stricture characteristics, including etiology, length, and anatomic location were analyzed and compared to urethroplasty type over the study period using chi-squared analysis to assess for linear trends within the group and by surgeon. Average stricture lengths for bulbar (2.8 ± 1.8 cm), penile (3.6 ± 2.6 cm), and penile-bulbar strictures (8.7 ± 5.0) remained stable. The most common stricture etiology was idiopathic/unknown in all study years (63%). In the bulbar urethra, the group performed significantly (1) fewer excisional repairs (-31%) and more substitutional repairs (+78%); (2) of substitutional repairs, more grafts are being placed dorsally (+95%) vs ventrally (-75%) (3) of the bulbar excisional repairs, more are being performed without transection of the bulbar urethra (+430%); and in the penile urethra (4) the fasciocutaneous flap is in decline (-86%), while single-stage dorsal repairs are increasing (+280%). Anterior urethroplasty techniques continue to evolve in the absence of robust clinical data or randomized controlled trials, with a general movement in this cohort toward an initial dorsal approach for most strictures. Inter- and intrasurgeon variability in the surgical management of similar strictures was noted, and the feasibility of any future randomized controlled trials, without apparent surgical equipoise, must be questioned.
Key Points
- Published in Urology in 2019.
- Indexed in PubMed as PMID 30880075.
- Mapped to Urethral Stricture & Urethroplasty, Outcomes, Methods & Education.
- Abstract available from PubMed and rendered as static text on this page.
Clinical Relevance
This article contributes to the urethral stricture and urethroplasty literature, with emphasis on staging, reconstruction, definitions of success, and long-term functional outcomes.