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Surgical Reconstruction of Failed Anterior Urethroplasty

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Textbook of Male Genitourethral Reconstruction

Abstract

Urethroplasty has proven to be a cost-effective first-line treatment option for urethral stricture disease. In contemporary series, long-term success rates exceed 90% for anastomotic techniques and 85% for substitution urethroplasty. Urethroplasty failure can often be successfully salvaged with a subsequent reconstructive procedure, the success rates of which approach 80% employing various novel reconstructive techniques.

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References

  1. Eltahawy EA, et al. Long-term followup for excision and primary anastomosis for anterior urethral strictures. J Urol. 2007;177(5):1803–6.

    PubMed  Google Scholar 

  2. Levine MA, Kinnaird AS, Rourke KF. Revision urethroplasty success is comparable to primary urethroplasty: a comparative analysis. Urology. 2014;84(4):928–32; quiz 932–3.

    PubMed  Google Scholar 

  3. Levy M, et al. The impact of age on urethroplasty success. Urology. 2017;107:232–8.

    PubMed  Google Scholar 

  4. Whitson JM, et al. Long-term efficacy of distal penile circular fasciocutaneous flaps for single stage reconstruction of complex anterior urethral stricture disease. J Urol. 2008;179(6):2259–64.

    PubMed  Google Scholar 

  5. Barbagli G, et al. Long-term followup and deterioration rate of anterior substitution urethroplasty. J Urol. 2014;192(3):808–13.

    PubMed  Google Scholar 

  6. Morey AF, Duckett CP, McAninch JW. Failed anterior urethroplasty: guidelines for reconstruction. J Urol. 1997;158(4):1383–7.

    CAS  PubMed  Google Scholar 

  7. Dalpiaz O, et al. Single-stage dorsal inlay split-skin graft for salvage anterior urethral reconstruction. BJU Int. 2008;101(12):1565–70.

    PubMed  Google Scholar 

  8. Joseph JV, et al. Urethroplasty for refractory anterior urethral stricture. J Urol. 2002;167(1):127–9.

    PubMed  Google Scholar 

  9. O’Riordan A, et al. Outcome of dorsal buccal graft urethroplasty for recurrent bulbar urethral strictures. BJU Int. 2008;102(9):1148–51.

    PubMed  Google Scholar 

  10. Blaschko SD, et al. Repeat urethroplasty after failed urethral reconstruction: outcome analysis of 130 patients. J Urol. 2012;188(6):2260–4.

    PubMed  PubMed Central  Google Scholar 

  11. Breyer BN, et al. Multivariate analysis of risk factors for long-term urethroplasty outcome. J Urol. 2010;183(2):613–7.

    PubMed  Google Scholar 

  12. Siegel JA, et al. Repeat excision and primary anastomotic urethroplasty for salvage of recurrent bulbar urethral stricture. J Urol. 2015;194(5):1316–22.

    PubMed  Google Scholar 

  13. Chapman D, Kinnaird A, Rourke K. Independent predictors of stricture recurrence following urethroplasty for isolated bulbar urethral strictures. J Urol. 2017;198(5):1107–12.

    PubMed  Google Scholar 

  14. Spencer J, et al. Hypoandrogenism is prevalent in males with urethral stricture disease and is associated with longer strictures. Urology. 2018;114:218–23.

    PubMed  Google Scholar 

  15. Hofer MD, et al. Low testosterone levels result in decreased periurethral vascularity via an androgen receptor-mediated process: pilot study in urethral stricture tissue. Urology. 2017;105:175–80.

    PubMed  Google Scholar 

  16. Hofer MD, Morey AF. Role of androgens for urethral homeostasis. Transl Androl Urol. 2018;7(4):521–5.

    PubMed  PubMed Central  Google Scholar 

  17. Viers BR, et al. Geriatric urethroplasty: lessons learned from urethral reconstruction in elderly men. J Urol. 2017;197(4):e1187.

    Google Scholar 

  18. Viers BR, et al. Urethral reconstruction in aging male patients. Urology. 2018;113:209–14.

    PubMed  Google Scholar 

  19. Viers BR, et al. Delayed reconstruction of bulbar urethral strictures is associated with multiple interventions, longer strictures and more complex repairs. J Urol. 2018;199(2):515–21.

    PubMed  Google Scholar 

  20. Rourke KF, Jordan GH. Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture. J Urol. 2005;173(4):1206–10.

    PubMed  Google Scholar 

  21. Culty T, Boccon-Gibod L. Anastomotic urethroplasty for posttraumatic urethral stricture: previous urethral manipulation has a negative impact on the final outcome. J Urol. 2007;177(4):1374–7.

    PubMed  Google Scholar 

  22. Roehrborn CG, McConnell JD. Analysis of factors contributing to success or failure of 1-stage urethroplasty for urethral stricture disease. J Urol. 1994;151(4):869–74.

    CAS  PubMed  Google Scholar 

  23. Viers BR, et al. Characteristics of idiopathic urethral strictures: a link to remote perineal trauma? Urology. 2017;110:228–33.

    PubMed  Google Scholar 

  24. Lumen N, et al. Etiology of urethral stricture disease in the 21st century. J Urol. 2009;182(3):983–7.

    PubMed  Google Scholar 

  25. Santucci RA, Mario LA, McAninch JW. Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol. 2002;167(4):1715–9.

    PubMed  Google Scholar 

  26. Sukumar S, et al. Multi-institutional outcomes of endoscopic management of stricture recurrence after bulbar urethroplasty. J Urol. 2018;200(4):837–42.

    PubMed  PubMed Central  Google Scholar 

  27. Erickson BA, Breyer BN, McAninch JW. The use of uroflowmetry to diagnose recurrent stricture after urethral reconstructive surgery. J Urol. 2010;184(4):1386–90.

    PubMed  PubMed Central  Google Scholar 

  28. Erickson BA, Breyer BN, McAninch JW. Changes in uroflowmetry maximum flow rates after urethral reconstructive surgery as a means to predict for stricture recurrence. J Urol. 2011;186(5):1934–7.

    PubMed  PubMed Central  Google Scholar 

  29. Johnson EK, Latini JM. The impact of urethroplasty on voiding symptoms and sexual function. Urology. 2011;78(1):198–201.

    PubMed  Google Scholar 

  30. Morey AF, et al. American urological association symptom index in the assessment of urethroplasty outcomes. J Urol. 1998;159(4):1192–4.

    CAS  PubMed  Google Scholar 

  31. Hoy NY, et al. Incidence and predictors of complications due to urethral stricture in patients awaiting urethroplasty. J Urol. 2018;199(3):754–9.

    PubMed  Google Scholar 

  32. Voelzke BB. Critical review of existing patient reported outcome measures after male anterior urethroplasty. J Urol. 2013;189(1):182–8.

    PubMed  Google Scholar 

  33. Warren GJ, Erickson BA. The role of noninvasive testing and questionnaires in urethroplasty follow-up. Transl Androl Urol. 2014;3(2):221–6.

    PubMed  PubMed Central  Google Scholar 

  34. Belsante MJ, et al. Cost-effectiveness of risk stratified followup after urethral reconstruction: a decision analysis. J Urol. 2013;190(4):1292–7.

    PubMed  Google Scholar 

  35. Barbagli G, Selli C, Tosto A. Reoperative surgery for recurrent strictures of the penile and bulbous urethra. J Urol. 1996;156(1):76–7.

    CAS  PubMed  Google Scholar 

  36. Pagliara T, et al. PD34-12 tertiary urethroplasty: is the third time a charm? J Urol. 2017;197(4):e661–2.

    Google Scholar 

  37. Rosenbaum CM, et al. Redo buccal mucosa graft urethroplasty: success rate, oral morbidity and functional outcomes. BJU Int. 2016;118(5):797–803.

    PubMed  Google Scholar 

  38. McLaughlin MD, et al. Buccal mucosal urethroplasty in patients who had multiple previous procedures. Urology. 2006;68(6):1156–9; discussion 1159.

    PubMed  Google Scholar 

  39. Kessler TM, Ryu G, Burkhard FC. Clean intermittent self-catheterization: a burden for the patient? Neurourol Urodyn. 2009;28(1):18–21.

    PubMed  Google Scholar 

  40. Lubahn JD, et al. Poor quality of life in patients with urethral stricture treated with intermittent self-dilation. J Urol. 2014;191(1):143–7.

    PubMed  Google Scholar 

  41. Armenakas NA, Morey AF, McAninch JW. Reconstruction of resistant strictures of the fossa navicularis and meatus. J Urol. 1998;160(2):359–63.

    CAS  PubMed  Google Scholar 

  42. Patel CK, et al. Outcomes for management of lichen sclerosus urethral strictures by 3 different techniques. Urology. 2016;91:215–21.

    PubMed  Google Scholar 

  43. Morey AF, et al. Fossa navicularis reconstruction: impact of stricture length on outcomes and assessment of extended meatotomy (first stage Johanson) maneuver. J Urol. 2007;177(1):184–7; discussion 187.

    PubMed  Google Scholar 

  44. Barbagli G, et al. Clinical outcome and quality of life assessment in patients treated with perineal urethrostomy for anterior urethral stricture disease. J Urol. 2009;182(2):548–57.

    PubMed  Google Scholar 

  45. Myers JB, Porten SP, McAninch JW. The outcomes of perineal urethrostomy with preservation of the dorsal urethral plate and urethral blood supply. Urology. 2011;77(5):1223–7.

    PubMed  Google Scholar 

  46. Orandi A. One-stage urethroplasty. Br J Urol. 1968;40(6):717–9.

    CAS  PubMed  Google Scholar 

  47. Quartey JK. One-stage penile/preputial cutaneous island flap urethroplasty for urethral stricture: a preliminary report. J Urol. 1983;129(2):284–7.

    CAS  PubMed  Google Scholar 

  48. McAninch JW, Morey AF. Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures. J Urol. 1998;159(4):1209–13.

    CAS  PubMed  Google Scholar 

  49. Simonato A, et al. The tongue as an alternative donor site for graft urethroplasty: a pilot study. J Urol. 2006;175(2):589–92.

    PubMed  Google Scholar 

  50. Song LJ, et al. Lingual mucosal grafts for anterior urethroplasty: a review. BJU Int. 2009;104(8):1052–6.

    PubMed  Google Scholar 

  51. Xu YM, et al. Oral complications after lingual mucosal graft harvesting for urethroplasty in 110 cases. BJU Int. 2011;108(1):140–5.

    PubMed  Google Scholar 

  52. Palmer DA, et al. Urethral reconstruction with rectal mucosa graft onlay: a novel, minimally invasive technique. J Urol. 2016;196(3):782–6.

    PubMed  Google Scholar 

  53. Hudak SJ, et al. Single-stage reconstruction of complex anterior urethral strictures using overlapping dorsal and ventral buccal mucosal grafts. BJU Int. 2012;110(4):592–6.

    PubMed  Google Scholar 

  54. Shakir NA, et al. Excision and primary anastomosis reconstruction for traumatic strictures of the pendulous urethra. Urology. 2018;125:234–8.

    Google Scholar 

  55. Morey AF, Kizer WS. Proximal bulbar urethroplasty via extended anastomotic approach – what are the limits? J Urol. 2006;175(6):2145–9; discussion 2149.

    PubMed  Google Scholar 

  56. Terlecki RP, et al. Grafts are unnecessary for proximal bulbar reconstruction. J Urol. 2010;184(6):2395–9.

    PubMed  Google Scholar 

  57. Barbagli G, et al. Dorsal free graft urethroplasty. J Urol. 1996;155(1):123–6.

    CAS  PubMed  Google Scholar 

  58. Vasudeva P, et al. Dorsal versus ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral stricture: a prospective randomized study. Int J Urol. 2015;22(10):967–71.

    PubMed  Google Scholar 

  59. Guralnick ML, Webster GD. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol. 2001;165(5):1496–501.

    CAS  PubMed  Google Scholar 

  60. Coursey JW, et al. Erectile function after anterior urethroplasty. J Urol. 2001;166(6):2273–6.

    CAS  PubMed  Google Scholar 

  61. Myers JB, McAninch JW. Surgery illustrated – surgical atlas: perineal urethrostomy. BJU Int. 2011;107:856–65.

    PubMed  Google Scholar 

  62. Parker DC, Morey AF, Simhan J. 7-flap perineal urethrostomy. Transl Androl Urol. 2015;4(1):51–5.

    PubMed  PubMed Central  Google Scholar 

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Correspondence to Boyd R. Viers .

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Miller, A., Morey, A.F., Viers, B.R. (2020). Surgical Reconstruction of Failed Anterior Urethroplasty. In: Martins, F.E., Kulkarni, S.B., Köhler, T.S. (eds) Textbook of Male Genitourethral Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-030-21447-0_18

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  • DOI: https://doi.org/10.1007/978-3-030-21447-0_18

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