MP32-11 DORSAL ONLAY SUBSTITUTION URETHROPLASTY FOR POSTERIOR URETHRAL STRICTURES

Rachel A. Mann; Anna J. Saltman; Jay Clifford; Jill C. Buckley; Dhruv Puri; Lee Zhao; Bradley A. Erickson; Kenan B. Ashouri; Alex J. Vanni

doi:10.1097/01.JU.0001008816.80828.35.11

INTRODUCTION AND OBJECTIVE: There are many techniques used to perform urethroplasty for posterior urethral strictures, with a notable lack of outcomes data after dorsal substitution urethroplasty. We sought to investigate post-operative stricture recurrence, erectile function, continence, and complications amongst this population. METHODS: Men with posterior urethral strictures who underwent dorsal substitution urethroplasty with oral mucosa grafts from four institutions from 2012-2023 were included. A minimum of 3 months follow-up was required. Patients were excluded if they had a pelvic fracture urethral injury or underwent revision urethroplasty. Cystoscopy was performed routinely at 3-6 months post-operatively and again as needed if new urinary symptoms developed. Anatomic urethroplasty success was defined by inability to pass 17 Fr flexible cystoscope, and functional success by no additional procedures. De novo erectile dysfunction and urinary incontinence were evaluated. RESULTS: A total of 219 men underwent posterior dorsal substitution urethroplasty, and 174 men completed 3 months follow-up required for study inclusion (Table 1). The etiology of stricture was iatrogenic in 13 (7.5%), radiation-induced in 4 (2.3%), due to prior bladder outlet procedures in 8 (4.6%), and idiopathic/other in 149 patients (85.6%). The median intraoperative stricture length was 5 cm (range 1-20 cm). At a median follow-up of 13.8 months, anatomic success was 89.7% and functional success was 91.4%. Post-operatively, 11 (6.3%) patients experienced new incontinence and 6 (3.4%) patients experienced new erectile dysfunction. 46 (26.4%) patients experienced a complication post-operatively; most commonly urinary tract infection (24, 13.8%), groin/perineal pain or numbness (9, 5.2%), or graft harvest site complications (8, 4.6%). Subgroup analysis was performed with patients who had a BMI of>40 (N=18). Outcomes in this cohort included a 100% anatomic and functional success, 1 (5.6%) experienced post-operative incontinence, 1 (5.6%) had new erectile dysfunction, and 5 (27.8%) experienced a post-operative complication. CONCLUSIONS: Dorsal onlay substitution for posterior urethral strictures has a high degree of success with low rates of post-operative erectile dysfunction, incontinence, and post-surgical complications.

MP32-11 DORSAL ONLAY SUBSTITUTION URETHROPLASTY FOR POSTERIOR URETHRAL STRICTURES

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