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Re-operative urethroplasty for failed prior urethral reconstruction: Outcomes of a 35 year experience
S146
Abstracts
Importantly, these costs are in addition to the significant health care costs incurred by guidelines-recommended cystoscopy, urinary cytology, and office visits. Further studies are needed to clarify the utility of this test, and the nature and magnitude of associated benefit, given the potential for substantial added costs.
Re-operative urethroplasty for failed prior urethral reconstruction: Outcomes of a 35 year experience Sarah D Blaschko, MD, Jack W McAninch, MD, FACS, FRCS, Jeremy B Myers, MD, Benjamin N Breyer, MD University of California San Francisco, San Francisco, CA INTRODUCTION: Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment of urethral strictures, fewer studies have addressed treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We sought to examine outcome results for re-operative urethroplasty.
J Am Coll Surg
An analysis of thromboembolic events after radical cystectomy and chemoprophylaxis recommendations Katie S Murray, DO, Ernesto Lopez-Corona, MD, Marcus Austenfeld, MD, Jeffrey M Holzbeierlein, MD, FACS University of Kansas, Kansas City, KS INTRODUCTION: Deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) is one of the most common causes of nonsurgical death in patients undergoing urologic surgery. The American Urological Association has set forth best practice statements for patients undergoing urological surgery regarding prophylaxis but no guidelines or recommendations. METHODS: We reviewed patients who underwent radical cystectomy with urinary diversion. Retrospectively, patients who underwent cystectomy without chemoprophylaxis or screening lower extremity Doppler ultrasound were evaluated. Over a time period a group of patients had post operative Doppler to evaluate for DVT. The last series of patients are those who received chemoprophylaxis and had screening ultrasounds.
RESULTS: Of 1156 cases, 168 patients underwent a re-operative urethroplasty after at least one failed prior urethroplasty. Patients median age was 44 years (range 11-75). Median follow-up was 12 months (range 1 month to 20.75 years). Overall, 139 patients (83%, 139/168) were successfully treated. For patients who failed, median time to failure was 18 months (range 7 months and 15.7 years).
RESULTS: From July 2007 until January 2012, 291 patients underwent radical cystectomy at the University of Kansas. Of 70 patients who underwent cystectomy from 2007 to 2008, four had a symptomatic DVT or PE (5.7%). Starting July 2008 until October 2010, while screening ultrasounds were being obtained out of 133 patients, 19 (14.2%) had asymptomatic or symptomatic thromboembolism. Screening ultrasounds were continued after October 2010 but heparin prophylaxis (5000 units pre operatively and 5000 units every 8 hours post operatively) was started. From this start date to current there have been 6 patients out of 88 (6.8%) with documented thromboembolic events identified post operatively. Since starting heparin prophylaxis no adverse bleeding events have been identified.
CONCLUSIONS: Re-operative urethroplasty is a successful treatment option for most men, but rates of success were lower than for men undergoing their first urethroplasty. Patients who failed treatment had longer strictures and more complex repairs.
CONCLUSIONS: Based on this ongoing evaluation it can be recommended that patients undergoing radical cystectomy should be given chemoprophylaxis throughout the hospitalization. This can be done with minimal adverse outcomes.
METHODS: A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with re-operative urethroplasty after failed prior urethral reconstruction. Stricture length, stricture location, re-operative urethroplasty intervention, and time until re-operative urethroplasty failure were evaluated.
Abstracts
Importantly, these costs are in addition to the significant health care costs incurred by guidelines-recommended cystoscopy, urinary cytology, and office visits. Further studies are needed to clarify the utility of this test, and the nature and magnitude of associated benefit, given the potential for substantial added costs.
Re-operative urethroplasty for failed prior urethral reconstruction: Outcomes of a 35 year experience Sarah D Blaschko, MD, Jack W McAninch, MD, FACS, FRCS, Jeremy B Myers, MD, Benjamin N Breyer, MD University of California San Francisco, San Francisco, CA INTRODUCTION: Male urethral stricture disease accounts for a significant number of hospital admissions and health care expenditures. Although much research has been completed on treatment of urethral strictures, fewer studies have addressed treatment of strictures in men with recurrent stricture disease after failed prior urethroplasty. We sought to examine outcome results for re-operative urethroplasty.
J Am Coll Surg
An analysis of thromboembolic events after radical cystectomy and chemoprophylaxis recommendations Katie S Murray, DO, Ernesto Lopez-Corona, MD, Marcus Austenfeld, MD, Jeffrey M Holzbeierlein, MD, FACS University of Kansas, Kansas City, KS INTRODUCTION: Deep vein thrombosis (DVT) and pulmonary thromboembolism (PE) is one of the most common causes of nonsurgical death in patients undergoing urologic surgery. The American Urological Association has set forth best practice statements for patients undergoing urological surgery regarding prophylaxis but no guidelines or recommendations. METHODS: We reviewed patients who underwent radical cystectomy with urinary diversion. Retrospectively, patients who underwent cystectomy without chemoprophylaxis or screening lower extremity Doppler ultrasound were evaluated. Over a time period a group of patients had post operative Doppler to evaluate for DVT. The last series of patients are those who received chemoprophylaxis and had screening ultrasounds.
RESULTS: Of 1156 cases, 168 patients underwent a re-operative urethroplasty after at least one failed prior urethroplasty. Patients median age was 44 years (range 11-75). Median follow-up was 12 months (range 1 month to 20.75 years). Overall, 139 patients (83%, 139/168) were successfully treated. For patients who failed, median time to failure was 18 months (range 7 months and 15.7 years).
RESULTS: From July 2007 until January 2012, 291 patients underwent radical cystectomy at the University of Kansas. Of 70 patients who underwent cystectomy from 2007 to 2008, four had a symptomatic DVT or PE (5.7%). Starting July 2008 until October 2010, while screening ultrasounds were being obtained out of 133 patients, 19 (14.2%) had asymptomatic or symptomatic thromboembolism. Screening ultrasounds were continued after October 2010 but heparin prophylaxis (5000 units pre operatively and 5000 units every 8 hours post operatively) was started. From this start date to current there have been 6 patients out of 88 (6.8%) with documented thromboembolic events identified post operatively. Since starting heparin prophylaxis no adverse bleeding events have been identified.
CONCLUSIONS: Re-operative urethroplasty is a successful treatment option for most men, but rates of success were lower than for men undergoing their first urethroplasty. Patients who failed treatment had longer strictures and more complex repairs.
CONCLUSIONS: Based on this ongoing evaluation it can be recommended that patients undergoing radical cystectomy should be given chemoprophylaxis throughout the hospitalization. This can be done with minimal adverse outcomes.
METHODS: A prospectively collected, single surgeon urethroplasty database was queried from 1977 to 2011 for patients treated with re-operative urethroplasty after failed prior urethral reconstruction. Stricture length, stricture location, re-operative urethroplasty intervention, and time until re-operative urethroplasty failure were evaluated.