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847 SHORT TERM OUTCOME OF CONTEMPORARY URETHROPLASTY AT A TERTIARY CARE CENTER
complications. Perineal drainage was removed at 12 hours and all patients were discharged the morning after surgery. Minor scrotal hematoma presented in 6 cases (24%). Urethal catheter was removed in three weeks. Two cases (8%) in the SU subgroup needed a suprapubic catheter due to urinary fistula formation and followed spontaneous resolution. All patients were continent after surgery and those with sexual life conserved potency. Urethrography + uroflow were performed at 6-months and patients were discharged after a follow-up of 24 months. Urethral dilatation was needed only in a case (4%) in the AU arm. Conclusions: Open reconstruction for complex urethral stricture with membranous involvement has been successful in 96% of the cases in this series. Despite our experience is limited, very proximal SU with dorsal oral mucosa seems equally effective and safe than an AU procedure. We perform this modified Barbagli´s technique for bulbo-membranous strictures longer than 4 cm with very satisfactory results.
847
Short term outcome of contemporary urethroplasty at a tertiary care center
Kluth L.A., Balzer O.E., Reiss P., Pfalzgraf D., Reimann F., Hansen J., Becker A., Isbarn H., Rink M., Heuer R., Riechardt S., Chun F.K.H., Eichelberg C., Engel O., Dahlem R., Fisch M., Ahyai S.A. University Medical Center Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany Introduction & Objectives: To evaluate the stricture free survival rate, adverse events and quality of life (QoL) of urethroplasty in the short term follow-up. Materials & Methods: We retrospectively evaluated our patients who underwent urethroplasty between 12/08 and 07/10 at the University Medical Center HamburgEppendorf, Germany. A standardized non-validated questionnaire was sent to all patients in September 2010. Primary end point was the stricture rate defined as no stricture recurrence. Secondary endpoints were adverse events and QoL. Results: Within 19 months 205 patients underwent urethroplasty due to urethral stricture at different localisations and extend. 144 patients (70%) with a mean age of 56 years (range 14-84) and a mean follow up of 10.2 months (1-22), responded to our questionnaire. Of this cohort 9%, 85% and 6% were treated by primary excision and re-anastomosis (EPA), buccal mucosa graft (BMG) and mesh graft (MG) urethroplasty, respectively. Overall, 18/144 (12.5%) recurrences were documented and specifically 0%, 14.3% and 12.5 % for EPA, BMG and MG. In univariable Kaplan Meier analyses there was no statistical significant difference concerning the stricture recurrence free survival between the three surgical techniques. Furthermore, no risk factor as localisation, stricture length and number of previous surgeries was identified for early stricture recurrence. Adverse events as incontinence, curvature, shortening and post void wiping out of the urethra were most often associated with MG urethroplasty. However, statistical significant difference was not shown (p>0.05). Neither, there was a statistical significant difference found in QoL nor satisfaction with surgical outcome between the three techniques of urethroplasty (p=0.7). Conclusions: At our center contemporary urethral surgery signifies a BMG for the majority of patients. Stricture recurrence free survival for EPA, BMG and MG seems comparable. However, EPA demonstrates excellent success rates of urethroplasty in the short term follow up. Differences in adverse events are not statistically significant between EPA, BMG and MG and do not seem to have an impact on quality of life and satisfaction of surgical outcome.
848
Assessment of the functional outcome after urethroplasty: A prospective analysis
Lumen N., Speers S., De Backer S., Pieters R., D'Hondt F., Everaert K., Oosterlinck W. University Hospital, Dept. of Urology, Ghent, Belgium Introduction & Objectives: Stricture recurrence after urethroplasty has always been the primary outcome parameter in studies about treatment of urethral strictures. Functional outcome concerning erectile function and urinary continence and patient’s satisfaction after urethroplasty has been poorly studied. Materials & Methods: A prospective analysis was done in 21 patients who underwent urethroplasty. An assessment of the maximum urinary flow (Qmax), the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF-5) and urinary continence (ICI-Q-SF) was done before urethroplasty and 6 weeks and 6 months after urethroplasty. Patients were also asked to score their satisfaction with the urethroplasty after 6 weeks and 6 months. Results: Three patients suffered a recurrence. The preoperative mean Qmax was 5.83 ml/s (range: 0-13 ml/s) and raised to 24.92 ml/s (range: 7-61.9 ml/s) 6 months postoperative (p<0.001). In the successful cases, the mean 6 months postoperative Qmax was 26.9ml/s versus 10.9ml/s in failures (p=0.03) The mean IPSS preoperative, 6 weeks and 6 months postoperative were respectively 15.96, 4.60 and 6.41. The scores after 6 weeks and 6 months were significantly better compared to the preoperative score. The mean IIEF-5 scores preoperative, 6 weeks and 6 months postoperative were respectively 15, 12.13 and 11.62. There was a mean decline (thus worsening) in IIEF-5 scores preoperative versus 6 weeks and 6 months postoperative. The mean differences in IIEF-5 scores preoperative and 6 weeks and 6 months postoperative didn’t reached statistical significance. One
Eur Urol Suppl 2011;10(2):268
of the most frequently reported preoperative complaints was urge incontinence. Eighteen (86%) patients reported urge incontinence: 11 occasional, 4 regular, 2 most of the time and 1 always. Only 4 patients (19%) reported no postvoid dribbling. In contrast, 10 (48%), 5 (24%) and 2 (9%) patients reported respectively occasional, frequent and always postvoid dribbling. The mean ICI-Q-SF score preoperative was 10.48. This score declined (thus an amelioration) to 8.33 and 9.47 respectively 6 weeks and 6 months postoperative. The mean difference in ICI-Q-SF score preoperative and 6 weeks postoperative even reached statistical significance. The postoperative decline in ICI-Q-SF score was mainly due to an amelioration in urge incontinence and postvoid dribbling. About the satisfaction with the operation, the mean scores 6 weeks and 6 months postoperative were respectively 17,14/20 and 17,12/20 . Conclusions: Urethroplasty leads to a significant improvement in urinary flow and IPSS and urinary continence is tending to improve. Although not significant, erectile function was slightly diminished after urethroplasty. Patient's satisfaction after urethroplasty is high. Functional outcome should be assessed when urethroplasty is performed.
849
The effect of gracilis muscle flap on success rate of posterior urethral anastomosis in extensive urethral defect
Lee S.R.1, Park D.S.1, Jeon H.G.1, Lee Y.T.1, Kim D.S.2 1 CHA Bundang Medical Center, CHA University, Dept. of Urology, Seongnam-Si, Gyeonggi-Do, South Korea, 2Myongji Hospital, Kwandong University College of Medicine, Dept. of Urology, Goyang-Si, Gyeonggi-Do, South Korea Introduction & Objectives: We evaluated a gracilis muscle flap as a contributing factor to a successful outcome of posterior urethral anastomosis (PUA) in urethral distraction defect more than 3 cm. Materials & Methods: Of the 238 patients who underwent urethral reconstruction for traumatic urethral injury between May 1998 and January 2009, a retrospective analysis was made of 96 patients who underwent delayed PUA with urethral defect more than 3 cm. The clinical outcome was defined as a failure when any postoperative treatment was required. Age, previously failed urethroplasty, urethral defect length, use of a gracilis muscle flap, time interval between original urethral injury and PUA, or between previous urethroplasty and PUA were evaluated as contributing factors to a successful outcome using univariate and multivariate analysis.
Results: Urethral defect was repaired with corporal separation in 20 patients, inferior pubectomy in 60, and urethral rerouting in 16. The overall success rate was 85.4% and mean follow-up period was 27.3±11.2 months (range, 8-50 months). Multivariate logistic regression analysis revealed that only the use of a gracilis muscle flap was significant contributing factor of success in PUA (OR=5.47, 95% CI=1.39-21.46, p=0.015) (Table.1). Conclusions: PUA with a gracilis muscle flap may be a viable option for long segment urethral distraction injury. Use of a gracilis muscle flap can be a contributing factor to a successful outcome in PUA. Especially, when perineal urethroplasty with procedure more than corporal separation was intended, gracilis muscle flap can be more helpful.
850
Multiple urethral strictures – surgery and results
Kogan M.I., Mitusov V.V., Shangichev A.V., Ametov R.E. Rostov State Medical University, Dept. of Urology, Rostov on Don, Russia Introduction & Objectives: Multifocal lesion is found in 7-10% of all cases of the urethral strictures (US) in males. The surgery tactics for such conditions remains uncertain. Materials & Methods: During 2003-2009, we operated on 472 patients with US, including 51 patients (10.8%) with multiple US, age 17-76. In 90.6% - recurrent disease after pelvic/urethral injuries and subsequent surgery elsewhere; 9.4%- the cause was inflammatory US. In 80% we observed 2-focal US, in 20% ≥ 3-focal. Combination of focal: 69.8% bulbar and penile, 11.3% membranous and penile, 15.1% various foci in the penile urethra, 3.8% subtotal lesion. The length of the lesion: 1–9 cm. The results were assessed in 2 groups: I (35 patients), where the urethral lumen was restored 'from center to periphery', II (16 patients) where the reconstruction was performed 'from periphery to center'.
847
Short term outcome of contemporary urethroplasty at a tertiary care center
Kluth L.A., Balzer O.E., Reiss P., Pfalzgraf D., Reimann F., Hansen J., Becker A., Isbarn H., Rink M., Heuer R., Riechardt S., Chun F.K.H., Eichelberg C., Engel O., Dahlem R., Fisch M., Ahyai S.A. University Medical Center Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany Introduction & Objectives: To evaluate the stricture free survival rate, adverse events and quality of life (QoL) of urethroplasty in the short term follow-up. Materials & Methods: We retrospectively evaluated our patients who underwent urethroplasty between 12/08 and 07/10 at the University Medical Center HamburgEppendorf, Germany. A standardized non-validated questionnaire was sent to all patients in September 2010. Primary end point was the stricture rate defined as no stricture recurrence. Secondary endpoints were adverse events and QoL. Results: Within 19 months 205 patients underwent urethroplasty due to urethral stricture at different localisations and extend. 144 patients (70%) with a mean age of 56 years (range 14-84) and a mean follow up of 10.2 months (1-22), responded to our questionnaire. Of this cohort 9%, 85% and 6% were treated by primary excision and re-anastomosis (EPA), buccal mucosa graft (BMG) and mesh graft (MG) urethroplasty, respectively. Overall, 18/144 (12.5%) recurrences were documented and specifically 0%, 14.3% and 12.5 % for EPA, BMG and MG. In univariable Kaplan Meier analyses there was no statistical significant difference concerning the stricture recurrence free survival between the three surgical techniques. Furthermore, no risk factor as localisation, stricture length and number of previous surgeries was identified for early stricture recurrence. Adverse events as incontinence, curvature, shortening and post void wiping out of the urethra were most often associated with MG urethroplasty. However, statistical significant difference was not shown (p>0.05). Neither, there was a statistical significant difference found in QoL nor satisfaction with surgical outcome between the three techniques of urethroplasty (p=0.7). Conclusions: At our center contemporary urethral surgery signifies a BMG for the majority of patients. Stricture recurrence free survival for EPA, BMG and MG seems comparable. However, EPA demonstrates excellent success rates of urethroplasty in the short term follow up. Differences in adverse events are not statistically significant between EPA, BMG and MG and do not seem to have an impact on quality of life and satisfaction of surgical outcome.
848
Assessment of the functional outcome after urethroplasty: A prospective analysis
Lumen N., Speers S., De Backer S., Pieters R., D'Hondt F., Everaert K., Oosterlinck W. University Hospital, Dept. of Urology, Ghent, Belgium Introduction & Objectives: Stricture recurrence after urethroplasty has always been the primary outcome parameter in studies about treatment of urethral strictures. Functional outcome concerning erectile function and urinary continence and patient’s satisfaction after urethroplasty has been poorly studied. Materials & Methods: A prospective analysis was done in 21 patients who underwent urethroplasty. An assessment of the maximum urinary flow (Qmax), the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF-5) and urinary continence (ICI-Q-SF) was done before urethroplasty and 6 weeks and 6 months after urethroplasty. Patients were also asked to score their satisfaction with the urethroplasty after 6 weeks and 6 months. Results: Three patients suffered a recurrence. The preoperative mean Qmax was 5.83 ml/s (range: 0-13 ml/s) and raised to 24.92 ml/s (range: 7-61.9 ml/s) 6 months postoperative (p<0.001). In the successful cases, the mean 6 months postoperative Qmax was 26.9ml/s versus 10.9ml/s in failures (p=0.03) The mean IPSS preoperative, 6 weeks and 6 months postoperative were respectively 15.96, 4.60 and 6.41. The scores after 6 weeks and 6 months were significantly better compared to the preoperative score. The mean IIEF-5 scores preoperative, 6 weeks and 6 months postoperative were respectively 15, 12.13 and 11.62. There was a mean decline (thus worsening) in IIEF-5 scores preoperative versus 6 weeks and 6 months postoperative. The mean differences in IIEF-5 scores preoperative and 6 weeks and 6 months postoperative didn’t reached statistical significance. One
Eur Urol Suppl 2011;10(2):268
of the most frequently reported preoperative complaints was urge incontinence. Eighteen (86%) patients reported urge incontinence: 11 occasional, 4 regular, 2 most of the time and 1 always. Only 4 patients (19%) reported no postvoid dribbling. In contrast, 10 (48%), 5 (24%) and 2 (9%) patients reported respectively occasional, frequent and always postvoid dribbling. The mean ICI-Q-SF score preoperative was 10.48. This score declined (thus an amelioration) to 8.33 and 9.47 respectively 6 weeks and 6 months postoperative. The mean difference in ICI-Q-SF score preoperative and 6 weeks postoperative even reached statistical significance. The postoperative decline in ICI-Q-SF score was mainly due to an amelioration in urge incontinence and postvoid dribbling. About the satisfaction with the operation, the mean scores 6 weeks and 6 months postoperative were respectively 17,14/20 and 17,12/20 . Conclusions: Urethroplasty leads to a significant improvement in urinary flow and IPSS and urinary continence is tending to improve. Although not significant, erectile function was slightly diminished after urethroplasty. Patient's satisfaction after urethroplasty is high. Functional outcome should be assessed when urethroplasty is performed.
849
The effect of gracilis muscle flap on success rate of posterior urethral anastomosis in extensive urethral defect
Lee S.R.1, Park D.S.1, Jeon H.G.1, Lee Y.T.1, Kim D.S.2 1 CHA Bundang Medical Center, CHA University, Dept. of Urology, Seongnam-Si, Gyeonggi-Do, South Korea, 2Myongji Hospital, Kwandong University College of Medicine, Dept. of Urology, Goyang-Si, Gyeonggi-Do, South Korea Introduction & Objectives: We evaluated a gracilis muscle flap as a contributing factor to a successful outcome of posterior urethral anastomosis (PUA) in urethral distraction defect more than 3 cm. Materials & Methods: Of the 238 patients who underwent urethral reconstruction for traumatic urethral injury between May 1998 and January 2009, a retrospective analysis was made of 96 patients who underwent delayed PUA with urethral defect more than 3 cm. The clinical outcome was defined as a failure when any postoperative treatment was required. Age, previously failed urethroplasty, urethral defect length, use of a gracilis muscle flap, time interval between original urethral injury and PUA, or between previous urethroplasty and PUA were evaluated as contributing factors to a successful outcome using univariate and multivariate analysis.
Results: Urethral defect was repaired with corporal separation in 20 patients, inferior pubectomy in 60, and urethral rerouting in 16. The overall success rate was 85.4% and mean follow-up period was 27.3±11.2 months (range, 8-50 months). Multivariate logistic regression analysis revealed that only the use of a gracilis muscle flap was significant contributing factor of success in PUA (OR=5.47, 95% CI=1.39-21.46, p=0.015) (Table.1). Conclusions: PUA with a gracilis muscle flap may be a viable option for long segment urethral distraction injury. Use of a gracilis muscle flap can be a contributing factor to a successful outcome in PUA. Especially, when perineal urethroplasty with procedure more than corporal separation was intended, gracilis muscle flap can be more helpful.
850
Multiple urethral strictures – surgery and results
Kogan M.I., Mitusov V.V., Shangichev A.V., Ametov R.E. Rostov State Medical University, Dept. of Urology, Rostov on Don, Russia Introduction & Objectives: Multifocal lesion is found in 7-10% of all cases of the urethral strictures (US) in males. The surgery tactics for such conditions remains uncertain. Materials & Methods: During 2003-2009, we operated on 472 patients with US, including 51 patients (10.8%) with multiple US, age 17-76. In 90.6% - recurrent disease after pelvic/urethral injuries and subsequent surgery elsewhere; 9.4%- the cause was inflammatory US. In 80% we observed 2-focal US, in 20% ≥ 3-focal. Combination of focal: 69.8% bulbar and penile, 11.3% membranous and penile, 15.1% various foci in the penile urethra, 3.8% subtotal lesion. The length of the lesion: 1–9 cm. The results were assessed in 2 groups: I (35 patients), where the urethral lumen was restored 'from center to periphery', II (16 patients) where the reconstruction was performed 'from periphery to center'.