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MP15-17 ASSESSMENT OF THE LEARNING CURVE FOR MALE URETHRAL RECONSTRUCTION: DOES EXPERIENCE MATTER?
Abstract   Open access   Peer reviewed

MP15-17 ASSESSMENT OF THE LEARNING CURVE FOR MALE URETHRAL RECONSTRUCTION: DOES EXPERIENCE MATTER?

Sarah Faris, Christopher Tam, Bryan Voelzke, Jeremy Myers, Sean Elliott, Alex Vanni, Thomas Smith, Benjamin Breyer, Thomas Gaither, Deep Bhatt, …
The Journal of urology, Vol.193(4S), pp.e165-e166
04/2015
DOI: 10.1016/j.juro.2015.02.900
url
https://doi.org/10.1016/j.juro.2015.02.900View
Published (Version of record) Open Access

Abstract

INTRODUCTION AND OBJECTIVES Urethral reconstruction has a historically high success rate, though is often technically demanding. Success rates are assumed to increase with surgeon experience, though the learning curve for these procedures has not been previously analyzed. METHODS We retrospectively reviewed all anterior urethroplasty cases from a prospectively maintained multiinstitutional reconstructive urologic database. Success was analyzed at the 18 month mark in all patients and defined as the freedom from secondary operation (e.g. urethral dilation, urethrotomy) for stricture recurrence. Success rates were analyzed relative to the total number of cases performed after fellowship training. Comparisons were made between surgeons and broken down by location and type of repair. RESULTS A total of 613 cases from 7 surgeons were analyzed, with an overall functional success rate of 87.3%. The success for bulbar repairs was higher than for penile repairs (88.2% vs 78.3%, p = 0.0116). The success of anastomotic repairs was higher than for substitution repairs (95.0% vs 82.4%, p = 0.0001). Figure 1 shows success rates by number of cases broken down by type of repair. Notably, there was an overall statistically significant trend towards improved outcomes by number of cases (p = 0.0422), which was most pronounced with bulbar repairs. There was no statistical improvement in penile repairs over time. The case number to reach proficiency (defined as a success rate of > 90%) was approximately 100 cases when all types of reconstruction was considered and 70 cases for bulbar urethroplasties. There were statistical differences in success rates for all types of repairs between the surgeons (p = 0.0014). CONCLUSIONS This study shows that success rates of anterior urethral reconstruction improve significantly as surgeon experience accumulates and proficiency occurs after approximately 100 cases. Additionally, significant differences in success rates were noted between surgeons. These findings highlight the potential opportunity to improve outcomes through continuing surgical education after fellowship training.

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