83 Patient reported complaints and complications after bulbar urethroplasty: A critical analysis of 292 patients

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Patient reported complaints and complications after bulbar urethroplasty: A critical analysis of 292 patients Eur Urol Suppl 2014;13;e83          

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Granieri M.A., Webster G.D., Fraser M.O., Peterson A.C. Duke University, Dept. of Surgery, Division of Urology, Durham, United States of America INTRODUCTION & OBJECTIVES: As utilization of urethroplasty, the gold standard for treating bulbar urethral stricture disease (USD), increases it becomes important to understand the spectrum of post-operative complications and patient reported complaints. We evaluated the above mentioned post-operative sequelae to describe the incidence and distribution of these complications and complaints after urethroplasty for bulbar USD. MATERIAL & METHODS: We performed an IRB approved retrospective review of all patients who underwent urethroplasty by two surgeons (GDW, ACP) from 1/1/2002 to 9/1/2011 at our facility. We recorded all post-operative complications and patient reported complaints. We classified them into the following categories: perioperative, infectious, anatomic, sexual dysfunction and voiding related. Fisher’s exact test was used to calculate statistical differences among repair types. RESULTS: We identified 325 men who underwent urethroplasty by two surgeons (GDW, ACP) for bulbar USD from January 2002 to September 2011.  292 (90%) men had sufficient data available to determine complications.  The mean follow up time was 12.1 months (+/7.3). 91 men (31%) reported a post-op complication/complaint.  Of these 91 men, 42 (46%) were classified as having a perioperative issue including scrotal/perineal neuralgia (28), scrotal/perineal hematoma (5), excessive wound drainage (5), thigh numbness (2), pulmonary embolism (3), wound separation (1), wound infection (1), cheek swelling (1), and peri-oral numbness (1). 17 (18.7%) were classified as infectious that included UTI (14), pyelonephritis (1), prostatitis (1), epididymitis (2), bladder calculus (1). 8 (8.8%) were classified as anatomic that included urethrocutaneous fistula (1), urethral diverticula (1), anastomotic skin/mucosal bridge (2), and penile curvature (4).   29 (9.9%) patients reported sexual complaints.  These include new onset post-op erectile dysfunction requiring treatment (24) and subjectively weak ejaculations (12).  Lastly, 4 patients (1.3%) developed new onset over active bladder or urge incontinence (OAB/UI) requiring medical therapy.  Table 1 lists the complications/complaints by repair type.  There were no statistically significant differences in complication rates among repair types.  Table 1:

 

            Patient Reported Complaints and Complications None(n) Peri-op(n) Infectious(n) Anatomic(n) Sexual(n) OAB/UI(n)

All (n=292)

68.8% (201)

14.4% (42)

5.8% (17)

2.7% (8)

9.9% (29)

1.4% (4)

Onlay (n=9)

67% (6)

22.2% (2)

0%

1.1% (1)

0%

0%

Augmented Anastomotic (n=85)

64.7% (55)

16.5% (14)

8.24% (7)

2.5% (3)

11.8% (10)

2.35% (2)

70.1% (129)

13.6% (25)

3.8% (7)

2.17% (4)

10.3% (19)

1.1% (2)

Excision& Primary Anastomosis

(n=184) Staged (n=1)

100% (1)

0%

0%

0%

0%

0%

Perineal Urethrostomy (n=12)

75% (9)

8.3% (1)

25% (3)

0%

0%

0%

Flap Based (n=1)

100% (1)

0%

0%

0%

0%

0%

P Value

0.90

0.79

0.07

0.35

0.76

0.71

CONCLUSIONS: To our knowledge, this is the largest database describing the full spectrum of complications and patient reported complaints after urethroplasty for bulbar USD. The majority of patients (69%) in our study had no complications or post-op complaints; however, the data indicates there is a wide spectrum of post-op sequelae with the most commonly reported patient complaint being scrotal/perineal neuralgia. Further analysis is warranted to elucidate the incidence, timing, and resolution of this phenomenon.