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Geriatrics
168
GERIATRICS
Geriatrics Dorsal Onlay Skin Graft Urethroplasty in Patients Older Than 65 Years C. Schwentner, J. Seibold, D. Colleselli, S. H. Alloussi, D. Schilling, K. D. Sievert, A. Stenzl and C. Radmayr Department of Urology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany Urology 2010; 76: 465– 470.
Objectives: Single-stage dorsal onlay graft urethroplasty is effective for anterior urethral reconstruction. Despite an aging population, the results of this technique in elderly patients have not yet been explicitly reported. We present our experience with dorsal onlay graft urethroplasty in this cohort. Methods: We reviewed all urethroplasties performed on males older than 65 years with at least 6 months follow-up. All exhibited extensive anterior urethral strictures precluding anastomotic urethroplasty. Dorsal onlay skin graft urethroplasty was done after stricturotomy using either penile or groin skin grafts. The neourethra was then tubularized in a single stage. Pre- and postoperative urethrograms, urethral ultrasound, and flow measurements were performed in all. Results: Forty-two men (mean age 69.25 years) underwent dorsal onlay urethroplasty. Mean graft length was 5.35 cm (range, 3–12). Penile skin was used in 29 and groin skin in 13. Average follow-up was 57.17 months (range, 29 – 82). Complications occurred in 4 (9.5%), including fistula formation and stricture recurrence. Final success rate was 90.5%. Compared with patients younger than 65 years, there were slightly more failures. Despite prolonged lithotomy position, we did not observe neurovascular lower extremity injuries. Perioperative complications were uncommon. Conclusions: Dorsal onlay skin graft urethroplasty can be reliably used in older men with extensive urethral strictures. Although recurrence rates seem to be slightly higher, urethroplasty is generally well tolerated in this cohort of patients. Given the favorable outcome of the dorsal onlay technique, urethral reconstruction should not be withheld solely on the basis of age. Regarding the lifelong benefits of repair, the increased complication rates appear negligible. Editorial Comment: In elderly men urethral stricture disease is most commonly related to iatrogenic change from urethral instrumentation. Surgical treatment, particularly for long anterior strictures, has changed significantly in recent years. Reconstructive techniques using substitution grafts have largely replaced endoscopic methods at many centers. Buccal mucosa grafts have become quite popular and have been used successfully in younger patients. However the usefulness of this tissue may be limited or contraindicated in the elderly due to underlying factors such as oral leukoplakia or use of dentures or other dental prostheses. This study examined surgical technique and clinical outcomes in a cohort of men with a mean age 69.25 years (range 65 to 83) who underwent dorsal onlay substitution urethroplasty using skin grafts. Clinical results were excellent, although complication rates were slightly higher compared to contemporaneous series of younger patients. As the authors note, substitution urethroplasty may be a viable option for patients of any age, and skin grafts may be a viable option in elderly patients when other techniques are not feasible. Tomas L. Griebling, M.D., M.P.H.
GERIATRICS
Geriatrics Dorsal Onlay Skin Graft Urethroplasty in Patients Older Than 65 Years C. Schwentner, J. Seibold, D. Colleselli, S. H. Alloussi, D. Schilling, K. D. Sievert, A. Stenzl and C. Radmayr Department of Urology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany Urology 2010; 76: 465– 470.
Objectives: Single-stage dorsal onlay graft urethroplasty is effective for anterior urethral reconstruction. Despite an aging population, the results of this technique in elderly patients have not yet been explicitly reported. We present our experience with dorsal onlay graft urethroplasty in this cohort. Methods: We reviewed all urethroplasties performed on males older than 65 years with at least 6 months follow-up. All exhibited extensive anterior urethral strictures precluding anastomotic urethroplasty. Dorsal onlay skin graft urethroplasty was done after stricturotomy using either penile or groin skin grafts. The neourethra was then tubularized in a single stage. Pre- and postoperative urethrograms, urethral ultrasound, and flow measurements were performed in all. Results: Forty-two men (mean age 69.25 years) underwent dorsal onlay urethroplasty. Mean graft length was 5.35 cm (range, 3–12). Penile skin was used in 29 and groin skin in 13. Average follow-up was 57.17 months (range, 29 – 82). Complications occurred in 4 (9.5%), including fistula formation and stricture recurrence. Final success rate was 90.5%. Compared with patients younger than 65 years, there were slightly more failures. Despite prolonged lithotomy position, we did not observe neurovascular lower extremity injuries. Perioperative complications were uncommon. Conclusions: Dorsal onlay skin graft urethroplasty can be reliably used in older men with extensive urethral strictures. Although recurrence rates seem to be slightly higher, urethroplasty is generally well tolerated in this cohort of patients. Given the favorable outcome of the dorsal onlay technique, urethral reconstruction should not be withheld solely on the basis of age. Regarding the lifelong benefits of repair, the increased complication rates appear negligible. Editorial Comment: In elderly men urethral stricture disease is most commonly related to iatrogenic change from urethral instrumentation. Surgical treatment, particularly for long anterior strictures, has changed significantly in recent years. Reconstructive techniques using substitution grafts have largely replaced endoscopic methods at many centers. Buccal mucosa grafts have become quite popular and have been used successfully in younger patients. However the usefulness of this tissue may be limited or contraindicated in the elderly due to underlying factors such as oral leukoplakia or use of dentures or other dental prostheses. This study examined surgical technique and clinical outcomes in a cohort of men with a mean age 69.25 years (range 65 to 83) who underwent dorsal onlay substitution urethroplasty using skin grafts. Clinical results were excellent, although complication rates were slightly higher compared to contemporaneous series of younger patients. As the authors note, substitution urethroplasty may be a viable option for patients of any age, and skin grafts may be a viable option in elderly patients when other techniques are not feasible. Tomas L. Griebling, M.D., M.P.H.