1 RECONSTRUCTION OF URETHRAL STRICTURES FOLLOWING PELVIC RADIATION THERAPY: COMPARISON OF RECONSTRUCTION TECHNIQUES

Vol. 187, No. 4S, Supplement, Saturday, May 19, 2012

Trauma/Reconstruction: Trauma & Reconstructive Surgery I Moderated Poster Saturday, May 19, 2012

1:00 PM-3:00 PM

1 RECONSTRUCTION OF URETHRAL STRICTURES FOLLOWING PELVIC RADIATION THERAPY: COMPARISON OF RECONSTRUCTION TECHNIQUES Jeffrey Zorn*, Adam Kinnaird, Keith Rourke, Edmonton, Canada INTRODUCTION AND OBJECTIVES: Radiation based treatments have proven useful in the management of pelvic malignancy. Urethral stricture is one of the complications of such treatment. The objective of this study is to report outcomes of urethral reconstruction for radiation induced urethral strictures. METHODS: A retrospective review of urethral reconstructions performed by a single surgeon (KR) at the University of Alberta from August 2003 to November 2010 was performed. Patients who underwent reconstruction for urethral strictures after radiation treatment in the form of External Beam Radiation Therapy (EBRT) or prostate Brachytherapy were identified. The primary outcome was urethral patency with secondary outcomes being incontinence and 90-day complication rates. Outcomes were compared between two reconstructive techniques (Excision and Primary Anastomosis versus Tissue Transfer) using the Fisher’s exact test and mean stricture length was compared using the unpaired t-test. RESULTS: During the study period, 507 urethral reconstructions were performed. Of these, 18 met our inclusion criteria including 11 and 7 reconstructions following EBRT and Brachytherapy, respectively. Reconstruction was performed by Excision and Primary Anastomosis (EPA) in 8 (44.4%) of the cases. The remaining patients required Tissue Transfer as either buccal mucosa graft (33.3%) or penile island flap (22.2%). Seventeen patients (94.4%) achieved cystoscopic patency with similar patency rates between the reconstructive techniques (EPA 100%; Tissue Transfer 90%; Not Significant). A 90-day complication rate of 22.2% was reported with 25% and 20% complication rates in the EPA and Tissue Transfer groups respectively (Not Significant). All the complications were Clavien Grade I-II. New onset or adverse change in incontinence occurred in 16.7% of patients. A significant difference was found between the reconstructive techniques with 25% of the EPA reconstructions versus 10% of the Tissue Transfer patients deemed incontinent at 6 months (p⫽0.013). The overall mean stricture length was 4.3cm. A significantly longer mean stricture length was found in the Tissue Transfer group (EPA 2.13cm vs. Tissue Transfer 6cm; p⫽0.0001). Mean follow-up was 41.1 months. CONCLUSIONS: Reconstruction of radiation induced urethral strictures yields satisfying rates of success in the outcomes measured. There are no differences in reconstructive technique with regard to urethral patency and 90-day complications. Anastomotic repairs are found to have significantly higher postoperative incontinence rates. Source of Funding: None

2 RISK FACTORS FOR URETHRAL STRICTURE AND BLADDER NECK CONTRACTURE FOLLOWING TRANSURETHRAL PROSTATECTOMY FOR BPH/LUTS Julia Fiuk*, Chicago, IL; Geoffrey R. Nuss, Arlington, TX; Christopher M. Gonzalez, Chicago, IL INTRODUCTION AND OBJECTIVES: Complications of transurethral prostatectomy (TURP) include urethral stricture and bladder neck contracture. Numerous factors have been hypothesized as the cause

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of this complication; however the specific etiology remains unknown. We sought to identify risk factors that predispose men to urethral stricture or bladder neck contracture following TURP. METHODS: A retrospective case control study was conducted at a single institution from 1999 to 2011 of 607 men undergoing TURP. Thirty-five patients diagnosed with post-TURP stricture were compared to an age matched control group of 105 patients who underwent TURP without developing subsequent stricture. Variables investigated included age, race, BMI, prostate size, preoperative PSA, resection time, TURP modality, resectoscope size, postoperative Foley size, time to postoperative catheter removal, and specific perioperative complications including urinary retention and symptomatic culture confirmed bacterial urinary tract infection. Logistic regression, general linear modeling and Chi squared analysis were conducted via SYSTAT. RESULTS: A total of 35 out of 607 consecutive patients (5.8%) developed stricture following TURP over a period of 12 years. Strictures were located at the bulbar urethra (n⫽ 16), bladder neck (n⫽ 6), penile urethra (n⫽4), multiple segments (n ⫽ 5), urethral meatus (n⫽1), or unspecified locations (n ⫽3). Monopolar TURP, symptomatic postoperative urinary tract infection, and immediate postoperative urinary retention were found to predict development of post TURP stricture (Table 1). Race, BMI, prostate size, bipolar TURP, laser prostatectomy, resectoscope size, postoperative Foley size and resection time were not statistically significant predictive variables. CONCLUSIONS: The use of monopolar TURP, postoperative UTI and urinary retention following TURP may predispose to stricture formation. The bulbar urethra appears to be the most common locations for post TURP stricture formation. Table 1: Factors predisposing to development of post-TURP stricture Odds 95% Confidence Factor Ratio Interval P-value Monopolar TURP 6.54 2.93–14.56 ⬍ 0.0001 Postoperative Urinary Retention

4.75

1.56–14.44

0.006

Symptomatic Urinary Tract Infection

8.74

2.24–34.13

0.001

Source of Funding: None

3 ONE-STAGE BULBAR URETHROPLASTY USING VENTRAL ORAL MUCOSAL ONLAY GRAFTING TECHNIQUES: RETROSPECTIVE ANALYSIS OF A HIGH VOLUME CENTER IN A HOMOGENOUS GROUP. Oliver Engel*, Luis Kluth, Armin Soave, Phillip Reiß, Roland Dahlem, Sascha Ahyai, Margit Fisch, Hamburg, Germany INTRODUCTION AND OBJECTIVES: There are many techniques used for open urethroplasty. Using flaps or different kinds of free transplants, as buccal mucosa or skingrafts, is common and described in literature. To analyze factors for stricture recurrence and quality of life data, it is important to use a very homogenous group of patients and not to mix different surgical techniques.We concentrated on patients who underwent a one-stage bulbar urethroplasty using ventral oral mucosal onlay grafting techniques. METHODS: We retrospectively analyzed patients of our urethroplasty database at the University Medical Center Hamburg-Eppendorf, who exclusively underwent a ventral oral mucosal onlay grafting. All patients were operated between 12/08 and 07/10. A standardized questionnaire was sent to all these patients. This questionnaire contained clinical history with preoperative treatments, questions about functional data, pain, sexuality, satisfaction and quality of life. Primary endpoint was the stricture free survival rate, defined as no stricture recurrence. RESULTS: Overall 98 patients underwent a bulbar urethroplasty between 12/08 and 7/10. 74 patients (76%) responded to our standardized questionnaire and were available for analyses. Mean age of our study cohort was 56 years (range 19-84) and the mean follow up was 10.2 month (3-22). 67 operations (90.5%) were successful and 7 patients (9.5%) developed a postoperative stricture. Short graft